BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE

    MDR report key: 10063484 · Received May 15, 2020

    Report

    Report Number
    2438477-2020-00028
    Event Type
    Injury
    Date Received
    May 15, 2020
    Report Date
    May 15, 2020
    Manufacturer
    HOMECARE ENTERPRISE CO., LTD.
    Product Code
    IPS
    UDI-DI
    00822383246451
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DRIVE DEVILBISS HEALTHCARE IS THE INITIAL IMPORTER OF THE DEVICE WHICH IS A CANE. CANE WAS NOT RETRIEVED FOR EVALUATION. CANE SNAPPED IN HALF WHILE IN USE. END-USER FELL AND BROKE HIS GLASSES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    525403 DRIVE CANE IPS HOMECARE ENTERPRISE CO., LTD. RTL10372BK 00822383246451

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR