MAUDE Adverse Event Report: TELEFLEX MEDICAL LMA SUPREME SIZE 4; AIRWAY, OROPHARYNGEAL, ANESTHE

Catalog Number	175040
Medical Device Problem Codes	Melted (1385); Device Damaged Prior to Use (2284)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/28/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
It was reported that: "the cuff was found damaged (appeared to have melted) upon opening the package.Therefore, a new unit was used instead.The issue was identified prior to use.".
Additional Manufacturer Narrative
(b)(4).The reported issue of damaged cuff could not be confirmed upon investigation of the returned sample.The customer returned the actual sample for investigation.Visual and functional analyses did not reveal any abnormalities with the sample.A device history record review was performed, and no relevant findings were identified.Based on the investigation of the returned complaint device, no issues were found.
Event or Problem Description
It was reported that: "the cuff was found damaged (appeared to have melted) upon opening the package.Therefore, a new unit was used instead.The issue was identified prior to use.".

• Brand Name: LMA SUPREME SIZE 4
• Common Device Name: AIRWAY, OROPHARYNGEAL, ANESTHE
• Manufacturer (Section D): TELEFLEX MEDICAL; athlone
• Manufacturer (Section G): THE LARYNGEAL MASK COMPANY (M) SDN. BHD; lot 19 , jalan hi-tech 3; zon industri fasa 1, kulim hi-tech park; kulim kedah 09090 ; MY 09090
• Manufacturer Contact: kevin don bosco ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 22042388
• Report Number: 3009307931-2025-00011
• Device Sequence Number: 8781403
• Product Code: CAE
• UDI-Device Identifier: 05060112310829
• UDI-Public: (01)05060112310829(11)231129(17)261128(10)11F23L0141(21)
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 04/28/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Catalogue Number: 175040
• Device Lot Number: 11F23L0141
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/28/2025
• Supplement Date Received by Manufacturer: 06/24/2025
• Initial Report FDA Received Date: 05/19/2025
• Supplement Report FDA Received Date: 06/26/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/29/2023
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown