BEUDAMED
    FDA Adverse Event Summary report: N

    DAILY ACTIVITY ASSIST DEVICES

    MDR report key: 2430237 · Received January 27, 2012

    Report

    Report Number
    1525712-2012-00185
    Date Received
    January 27, 2012
    Date of Event
    January 13, 2012
    Report Date
    January 27, 2012
    Manufacturer
    POPULAR PLASTICS
    Product Code
    IKX
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    CONSUMER SAT ON CHAIR AND IT ALLEGEDLY BROKE CAUSING CONSUMER TO FALL INTO TUB. NO INJURY ALLEGED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DAILY ACTIVITY ASSIST DEVICES 890.5050 IKX POPULAR PLASTICS 9781

    Patients

    Seq Age Sex Outcome Treatment
    1 Other