BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LIFESTYLES WARM LOVIN'

    MDR report key: 4309889 · Received October 14, 2014

    Report

    Report Number
    1019632-2014-00015
    Event Type
    Injury
    Date Received
    October 14, 2014
    Report Date
    October 14, 2014
    Manufacturer
    IDS MFG LIMITED
    Product Code
    NUC
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    KY, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). - ANSELL HEALTHCARE PRODUCTS LLC IS SUBMITTING THIS REPORT ON BEHALF OF (B)(4).

    Description of Event or Problem · 1

    THE CUSTOMER INFORMED ANSELL HEALTHCARE PRODUCTS, LLC THAT AFTER USING A LIFESTYLES PERSONAL LUBRICANT HE EXPERIENCED A SEVERE ALLERGIC REACTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    651457 LIFESTYLES WARM LOVIN' PERSONAL LUBRICANT NUC IDS MFG LIMITED 11120605DR

    Patients

    Seq Age Sex Outcome Treatment
    1 Other