| Brand Name | NobelActive Internal NP 3.5x10mm |
| Common Device Name | Endosseous Dental Implant |
| Manufacturer (Section D) |
| Nobel Biocare AB Göteborg |
| västra hamngatan 1 |
| göteborg 41117 |
| SW 41117 |
|
| Manufacturer (Section G) |
| Nobel Biocare AB Göteborg |
| västra hamngatan 1 |
|
| göteborg 41117 |
|
SW
41117
|
|
| Manufacturer Contact |
|
gayco
meel
|
| heierkerweg 1b |
| venlo 5928 -RM
|
|
NL
5928 RM
|
|
+031()623202508
|
|
| MDR Report Key | 50925420 |
| Report Number | 9611993-2026-135702 |
| Device Sequence Number | 12111030 |
| Product Code |
DZE
|
| UDI-Device Identifier | 07332747160024 |
| UDI-Public | (01)07332747160024(10)13197535(17)300907 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | SP |
| PMA/510(K) Number | K071370 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2026 |
| Device Explanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional |
| Initial Reporter Occupation |
Dentist
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/28/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
No
|
| Operator of Device |
Health Professional
|
| Device Catalogue Number | 34125 |
| Device Lot Number | 13197535 |
| Was Device Available for Evaluation? |
Yes
|
| Date Returned to Manufacturer | 09/24/2026 |
| Is the Reporter a Health Professional? |
Yes
|
| Initial Date Received by Manufacturer | 09/20/2026 |
| Initial Report FDA Received Date | 09/28/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Device Not Returned to Manufacturer
|
| Date Device Manufactured | 09/08/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Age | 67 YR |
| Patient Sex | Female |