inforMED
InjuryDYJ

CLEAR ORTHO RETAINER

Received Oct 6, 2023

Report 3011649314-2023-00622 · MDR key 17888792

Device

Generic name

Thermoform Retainer

Lot number

1116856385

Product problems

  • Insufficient Device Problem Information
  • Insufficient Device Problem Information

Patient

Prefer Not To Disclose

  • Hypersensitivity/Allergic reaction
  • Hypersensitivity/Allergic reaction

Narrative

Description of Event or Problem

IT WAS REPORTED THAT THE PATIENT HAD A REACTION TO THE CLEAR ORTHO RETAINER THAT WAS ISSUED. IT IS UNCLEAR WHEN THE PATIENT RECEIVED THE DEVICE, WHEN THE PATIENT FIRST USED THE DEVICE, OR WHEN THE REACTION OCCURRED OR RESOLVED. IT IS NOTED THAT THE PATIENT EXPERIENCED INTRAORAL BLISTERS, REDNESS, AND IRRITATIONS. THE DEVICE WAS WORN IN THE MORNING AND THE SYMPTOMS RESOLVED 30 MINUTES AFTER THE DEVICE WAS TAKEN OFF. THERE ARE NO REPORTED ALLERGIES.

Additional Manufacturer Narrative

THE DEVICE HAS NOT BEEN RETURNED. IF/WHEN THERE IS MORE INFORMATION PROVIDED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.