BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MECHANICAL WALKER, ROLLATOR

    MDR report key: 2898297 · Received January 7, 2013

    Report

    Report Number
    9616091-2013-00010
    Event Type
    Malfunction
    Date Received
    January 7, 2013
    Report Date
    January 4, 2013
    Manufacturer
    INVAMEX
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATED THAT A FORK ON A 12120-37-746 DOLOMITE ROLLATOR HAS BROKEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    7982 MECHANICAL WALKER, ROLLATOR 890.3825 ITJ INVAMEX 12120-37-746

    Patients

    Seq Age Sex Outcome Treatment
    1 39 Other