MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2019-10-25 for INVISALIGN SYSTEM VIVERA RETAINERS 8580 manufactured by Align Technology, Inc..
| Report Number | 2953749-2019-02761 |
| MDR Report Key | 9241495 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2019-10-25 |
| Date of Report | 2019-10-17 |
| Date of Event | 2019-09-01 |
| Date Mfgr Received | 2019-09-26 |
| Device Manufacturer Date | 2019-07-09 |
| Date Added to Maude | 2019-10-25 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | DENTIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. RYAN HOFFMEISTER |
| Manufacturer Street | 2820 ORCHARD PARKWAY |
| Manufacturer City | SAN JOSE CA 95134 |
| Manufacturer Country | US |
| Manufacturer Postal | 95134 |
| Manufacturer Phone | 4087891588 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | INVISALIGN SYSTEM |
| Generic Name | MAINTAINER, SPACE PREFORMED, ORTHODONTIC |
| Product Code | DYT |
| Date Received | 2019-10-25 |
| Model Number | VIVERA RETAINERS |
| Catalog Number | 8580 |
| Lot Number | 30342305 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ALIGN TECHNOLOGY, INC. |
| Manufacturer Address | 2820 ORCHARD PARKWAY SAN JOSE CA 95134 US 95134 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2019-10-25 |