MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2019-11-14 for LARYSEAL CLEAR LARYNGEAL MASK AIRWAY SIZE 5 038-94-350U manufactured by Flexicare Medical Dongguan Ltd..
| Report Number | 3006061749-2019-00012 |
| MDR Report Key | 9320478 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2019-11-14 |
| Date of Report | 2019-11-05 |
| Date of Event | 2019-10-03 |
| Date Mfgr Received | 2019-10-07 |
| Device Manufacturer Date | 2017-05-01 |
| Date Added to Maude | 2019-11-14 |
| 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 | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR RICHARD DOWNS |
| Manufacturer Street | CYNON VALLEY BUSINESS PARK |
| Manufacturer City | MOUNTAIN ASH, CF454ER |
| Manufacturer Country | UK |
| Manufacturer Postal | CF45 4ER |
| Manufacturer G1 | FLEXICARE MEDICAL DONGGUAN LTD. |
| Manufacturer Street | NO. B-15 XICHENG IND ZONE 1 HENGLI TOWN |
| Manufacturer City | DONGGUAN CITY, 523460 |
| Manufacturer Country | CH |
| Manufacturer Postal Code | 523460 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LARYSEAL CLEAR LARYNGEAL MASK AIRWAY SIZE 5 |
| Generic Name | LARYNGEAL MASK AIRWAY (LMA) |
| Product Code | CAE |
| Date Received | 2019-11-14 |
| Catalog Number | 038-94-350U |
| Lot Number | 170501396 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | FLEXICARE MEDICAL DONGGUAN LTD. |
| Manufacturer Address | NO. B-15 XICHENG IND ZONE 1 HENGLI TOWN DONGGUAN CITY, 523460 CH 523460 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-11-14 |