MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 04 report with the FDA on 2015-04-29 for LIFESTYLES SKIN 7312 manufactured by Suretex Ltd..
[5827921]
The customer informed ansell healthcare products, llc that after using a (b)(6)polyisoprene lubricated condom, his partner developed burning that required medical attention.
Patient Sequence No: 1, Text Type: D, B5
[13139748]
(b)(4).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1019632-2015-00005 |
| MDR Report Key | 4741908 |
| Report Source | 04 |
| Date Received | 2015-04-29 |
| Date of Report | 2015-04-29 |
| Date Facility Aware | 2015-04-28 |
| Report Date | 2015-04-29 |
| Date Reported to FDA | 2015-04-29 |
| Date Reported to Mfgr | 2015-04-29 |
| Date Mfgr Received | 2015-04-29 |
| Device Manufacturer Date | 2014-08-01 |
| Date Added to Maude | 2015-05-04 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Street | 1635 INDUSTRIAL RD. |
| Manufacturer City | DOTHAN AL 36303 |
| Manufacturer Country | US |
| Manufacturer Postal | 36303 |
| Manufacturer Phone | 3346152566 |
| Manufacturer G1 | SURETEX LTD. |
| Manufacturer Street | PLOT NO.74 TO 91, KIADB IND. ESTATE JIGANI-2ND PHASE |
| Manufacturer City | ANEKAI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LIFESTYLES SKIN |
| Generic Name | LUBRICATED POLYISOPRENE CONDOM |
| Product Code | MOL |
| Date Received | 2015-04-29 |
| Catalog Number | 7312 |
| Lot Number | 1408P20722 |
| Device Expiration Date | 2019-07-31 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | 2 YR |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SURETEX LTD. |
| Manufacturer Address | BANGALORE IN |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2015-04-29 |