| Brand Name | LATITUDE COMMUNICATOR |
| Common Device Name | EXTERNAL COMMUNICATOR |
| Manufacturer (Section D) |
| JABIL CIRCUIT (SHANGHAI) LTD |
| 600 tian lin rd |
| shanghai |
| CH |
|
| Manufacturer (Section G) |
| JABIL CIRCUIT SHANGHAI LTD |
| 600 tian lin rd |
|
| shanghai, 020 20023 3 |
|
CH
200233
|
|
| Manufacturer Contact |
|
timothy
degroot
|
| 4100 hamline avenue north |
| saint paul, MN 55112
|
|
6515826168
|
|
| MDR Report Key | 25023835 |
| Report Number | 2124215-2026-22920 |
| Device Sequence Number | 10127235 |
| Product Code |
OSR
|
| UDI-Device Identifier | 00802526585609 |
| UDI-Public | (01)00802526585609 |
| Combination Product (Y/N) | N |
| Initial Reporter State | IL |
| Initial Reporter Country | US |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Consumer,Company Representative |
| Initial Reporter Occupation |
Other
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
06/16/2026 |
| 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 |
Lay User/Patient
|
| Device Model Number | 6290 |
| Device Catalogue Number | 6290 |
| Device Lot Number | 6260788 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 04/16/2026 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 04/13/2026 |
| Supplement Date Received by Manufacturer | 06/08/2026
|
| Initial Report FDA Received Date | 04/28/2026 |
| Supplement Report FDA Received Date | 06/16/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| 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 Age | 54 YR |
| Patient Sex | Male |
|
|