BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ROLLATOR

    MDR report key: 11444737 · Received March 9, 2021

    Report

    Report Number
    3012316249-2021-00010
    Event Type
    Injury
    Date Received
    March 9, 2021
    Date of Event
    October 9, 2019
    Report Date
    March 9, 2021
    Product Code
    ITJ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    IL, US
    Reporter Occupation
    003

    Narratives

    Description of Event or Problem · 1

    NOTICE FROM ATTORNEY: PURCHASED HEAVY-DUTY ROLLATOR AND WALKER SEAT FULLY ASSEMBLED FROM DOCTORS CHOICE HOME MEDICAL EQUIPMENT, INC. PURCHASE DATE OF PRODUCT 9/27/2019. WITHIN 14 DAYS OF ACCEPTING DELIVERY WHEN PLAINTIFF ATTEMPTED TO SIT ON THE ROLLATOR WITH WALKER SEAT ATTACHMENT, THE ROLLATOR BROKE AND COLLAPSED, CAUSING HIM TO FALL TO THE GROUND. AS A DIRECT AND PROXIMATE RESULT OF THE FOREGOING, PLAINTIFF HAS BEEN INJURED, HE HAS SUFFERED AND WILL CONTINUE TO SUFFER, HE HAS INCURRED PAIN, DISABILITY, DISFIGUREMENT, MEDICAL EXPENSE, LOST INCOME AND WILL CONTINUE TO INCUR THESE DAMAGES IN THE FUTURE, AND HE HAS BEEN AND WILL CONTINUED TO BE RESTRICTED FROM PURSUING HIS USUAL ACTIVITIES AND AFFAIRS. DEVICE AND MANUFACTURER IS UNKNOWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    344726 ROLLATOR ITJ

    Patients

    Seq Age Sex Outcome Treatment
    1 Other