| Report Number | 3006061749-2020-00001 |
| MDR Report Key | 9711005 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2020-02-14 |
| Date of Report | 2020-02-14 |
| Date of Event | 2020-01-15 |
| Date Mfgr Received | 2020-01-16 |
| Device Manufacturer Date | 2019-06-01 |
| Date Added to Maude | 2020-02-14 |
| 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, RCT 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, GUANGDONG 523460 |
| Manufacturer Country | CH |
| Manufacturer Postal Code | 523460 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |