BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DIC

    MDR report key: 1878194 · Received October 18, 2010

    Report

    Report Number
    MW5017816
    Event Type
    Injury
    Date Received
    October 18, 2010
    Date of Event
    August 31, 2010
    Report Date
    September 3, 2010
    Manufacturer
    DALTON MEDICAL
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PT'S HEMI-WALKER BROKE AT THE FRONT LEFT HINGE CAUSING THE PT TO FALL. PT WAS TRANSPORTED TO THE ER AND RELEASED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DIC HEMI WALKER ITJ DALTON MEDICAL A-WA6005HEM WA5G807041

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Hospitalization