FDA.reportPublic FDA data

MAUDE MDR 3851273

MDR report key
3851273
Report number
MW5036441
Event key
0
Event type
3
Date of event
2014-05-17
Date received
2014-05-30
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
305
Health professional
0
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Report source
P
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1LATEX GLOVESLATEXLYY N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-05-3001. H; 2. L; 3. R

Event Narratives#

D

Patient 1

ON (B)(6) 2014 MY BOYFRIEND AND I WERE EATING AT (B)(6) WHEN I HAD AN ANAPHYLACTIC REACTION. INITIALLY, I WAS EATING A STUFFED MUSHROOM WHEN MY THROAT FELT TIGHT. THE WAITRESS TOOK IT BACK AND WHEN I QUESTIONED HER ABOUT HOW IT WAS COOKED, SHE SAID LATEX GLOVES ARE WORN IN THE KITCHEN. I ASKED FOR A SALAD TO BE MADE SEPARATELY WITHOUT GLOVES. I BEGAN TO EAT THAT AND MY THROAT STARTED CLOSING TIGHTER AND I HAD HIVES ON MY NECK AND CHEST. I TOOK BENADRYL AND DID MY EPI PEN WHILE 911 WAS CALLED. I HAVE A SEVERE LATEX ALLERGY.