BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE MEDICAL

    MDR report key: 2255145 · Received August 17, 2011

    Report

    Report Number
    2438477-2011-00012
    Event Type
    Injury
    Date Received
    August 17, 2011
    Date of Event
    June 10, 2011
    Report Date
    July 18, 2011
    Manufacturer
    JAN MAO INDUSTRIES, CO., LTD.
    Product Code
    ITJ
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    DRIVE MEDICAL HAS RECEIVED A CUSTOMER COMPLAINT ON A WALKER ORIGINALLY IMPORTED BY DRIVE MEDICAL. IT WAS ALLEGED THAT ONE OF THE LEGS ON THE WALKER BENT CAUSING THE PT TO FALL TO THE GROUND, BREAKING HIS LEFT SHOULDER. THIS MDR REPORT IS BASED ON THE CUSTOMER COMPLAINT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DRIVE MEDICAL WALKER ITJ JAN MAO INDUSTRIES, CO., LTD. 10243 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Required Intervention