BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDURANCE HD WALKER

    MDR report key: 1513339 · Received October 12, 2009

    Report

    Report Number
    1056127-2009-00018
    Event Type
    Malfunction
    Date Received
    October 12, 2009
    Date of Event
    September 14, 2009
    Report Date
    September 16, 2009
    Manufacturer
    ESSENTIAL MEDICAL SUPPLY, INC.
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    PATIENT USES ROLLATOR AS A TRANSPORTATION DEVICE, EVEN THOUGH HE HAS A WHEELCHAIR AVAILABLE TO HIM. HE TRANSPORTS HIMSELF OVER A VARIETY OF SURFACES. MULTIPLE MEDICAL DIAGNOSIS CONTRAINDICATE USE OF ROLLATOR.

    Description of Event or Problem · 1

    PATIENT STATES HE ROLLED INTO ELEVATOR AT HIS APARTMENT, TURNED AROUND TO SIT ON WALKER AND CASTER CAME OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDURANCE HD WALKER ROLLATOR ITJ ESSENTIAL MEDICAL SUPPLY, INC. W1801

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR