BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SMILEDIRECTCLUB ALIGNER SYSTEM

    MDR report key: 12204808 · Received July 21, 2021

    Report

    Report Number
    3014658399-2021-00010
    Event Type
    Injury
    Date Received
    July 21, 2021
    Date of Event
    June 21, 2021
    Report Date
    July 21, 2021
    Manufacturer
    ACCESS DENTAL LAB
    Product Code
    NXC
    PMA / PMN Number
    K191990
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 1

    BASED ON THE INFORMATION PROVIDED BY THE PATIENT AND INTERNAL INVESTIGATION CONDUCTED BY ACCESS DENTAL LAB, THERE IS NO CONCLUSIVE EVIDENCE THAT SUPPORTS OR OPPOSES THE FACT THAT THE ALIGNERS CAUSED, CONTRIBUTED OR WOULD LIKELY CAUSE OR CONTRIBUTE TO THE REPORTED EVENT. THIS EVENT IS BEING FILED AS AN MDR SINCE THE PATIENT REPORTED SYMPTOMS OR PHYSIOLOGICAL CONDITIONS RELATED TO LOSS OF A TOOTH.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT DUE TO THE USE OF ALIGNERS SHE LOST A TOOTH. AS A CONSEQUENCE, THE USE OF ALIGNERS WAS DISCONTINUED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1100884 SMILEDIRECTCLUB ALIGNER SYSTEM SEQUENTIAL ALIGNER NXC ACCESS DENTAL LAB N/A N/A

    Patients

    Seq Age Sex Outcome Treatment
    1 29 YR Other