N
Patient 1
IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.
MAUDE MDR 9770003
- MDR report key
- 9770003
- Report number
- 2936999-2020-00173
- Event key
- 0
- Event type
- 3
- Date of event
- 2019-07-15
- Date received
- 2020-02-28
- Adverse event
- 3
- Product problem
- 3
- Patients in event
- 0
- Reporter occupation
- 0
- Health professional
- 3
- Initial report to FDA
- 3
- Event location
- 3
Related Records
Manufacturer Contact
- Contact
- AVI KLUGER
- Address
- 15 HAMPSHIRE STREET MANSFIELD MA 02048 US
- Phone
- 303-303-3035
- Report source
- M
- Manufacturer link flag
- Y
Devices
| Seq | Brand | Generic | Manufacturer | Product code | Model | Catalog | Lot | PMA | 510(k) | Implant | Evaluated | Availability |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | NELLCOR | OXIMETER | MEDIANA CO. LTD. | DQA | 10005941J | 10005941J | * | N |
Patients
| Sequence | Received | Treatment | Outcome |
|---|---|---|---|
| 1 | 2020-02-28 | 0 | 1. D |
Event Narratives
D
Patient 1
ACCORDING TO THE REPORTER, THE PATIENT WAS USING THE DEVICE AT HOME AND DIED. ADDITIONAL INFORMATION ON THE CAUSE OF DEATH AND DETAILS SURROUNDING THE EVENT COULD NOT BE PROVIDED. THERE IS NO ALLEGED FAILURE OF THE DEVICE AND NO INFORMATION TO SUGGEST THE DEVICE IS RELATED TO THE PATIENT DEATH.
Related GUDID Devices By Product Code
Related PMN/PMA Records By Product Code
| Type | Submission | Product code | Device | Applicant | Decision date |
|---|---|---|---|---|---|
| 510(k) | K252655 | DQA | Pulse Oximeter (PO-A2AO, PO-A2AT, PO-A3AO, PO-H1AO, PO-B1AO, PO-C5AO, PO-C5AT, PO-C6AO, PO-C6AT) | Shenzhen Imdk Medical Technology Co., Ltd. | 2026-05-11 |
| 510(k) | K253887 | DQA | Nasal Alar SpO2 Sensor (989803205381); Nasal Alar SpO2 Sensor (989803205391); Nasal Alar Sp02 Sensor (989803205401) | Philips Medizin Systeme | 2026-05-01 |
| 510(k) | K260931 | DQA | Unimed Reusable Finger Clip SpO2 Sensors (U403-49R and U103-49R) | Unimed Medical Supplies, Inc. | 2026-04-14 |
| 510(k) | K252448 | DQA | AViTA Pulse Oximeter (SP61) | Avita Corporation | 2026-02-27 |
| 510(k) | K252805 | DQA | YUWELL® Finger Pulse Oximeter (YX105, YX106, YX110, YX310) | Jiangsu Yuyue Medical Equipment & Supply Co., Ltd. | 2026-02-17 |