MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,04 report with the FDA on 2010-02-18 for HUDSON AEROSOL ELONGATED ADULT MASK 1083 manufactured by Teleflex Medical.
[20217071]
The event is reported as: mask had no oxygen flow. When it was examined, it had a piece of plastic completely blocking the venturi adapter. No patient injury reported.
Patient Sequence No: 1, Text Type: D, B5
[20609765]
The defective product has been requested but not received in time for this report. A follow-up investigation report will be sent when completed.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3004365956-2010-00015 |
| MDR Report Key | 1613125 |
| Report Source | 01,04 |
| Date Received | 2010-02-18 |
| Date of Report | 2010-01-20 |
| Date of Event | 2009-12-30 |
| Date Mfgr Received | 2010-01-20 |
| Date Added to Maude | 2010-08-23 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | ANGELA BROWN |
| Manufacturer Street | P.O. BOX 12600 |
| Manufacturer City | RTP NC 27709 |
| Manufacturer Country | US |
| Manufacturer Postal | 27709 |
| Manufacturer Phone | 9194334901 |
| Manufacturer G1 | TELEFLEX MEDICAL |
| Manufacturer Street | AVE. TRANSFORMACION 5954 PARQUE INDUSTRIAL FINSA |
| Manufacturer City | NUEVO LAREDO 88275 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 88275 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HUDSON AEROSOL ELONGATED ADULT MASK |
| Generic Name | ELONGATED ADULT MASK |
| Product Code | CBP |
| Date Received | 2010-02-18 |
| Model Number | NA |
| Catalog Number | 1083 |
| Lot Number | 2712041-1 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TELEFLEX MEDICAL |
| Manufacturer Address | NUEVO LAREDO MX |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2010-02-18 |