BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EXCALIBUR WALKER

    MDR report key: 1780948 · Received July 29, 2010

    Report

    Report Number
    1056127-2010-00004
    Event Type
    Injury
    Date Received
    July 29, 2010
    Date of Event
    May 14, 2010
    Report Date
    July 6, 2010
    Manufacturer
    PINGHU ASPEL TECHNOLOGY CORP.
    Product Code
    ITJ
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    SC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    FRONT CASTER OF WALKER DETACHED WHILE PT WAS SEATED. PT FELL TO THE FLOOR AND BROKE CLAVICAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EXCALIBUR WALKER ROLLATOR ITJ PINGHU ASPEL TECHNOLOGY CORP. W1635 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Other