FDA Adverse Event Summary report: N

DAILY ACTIVITY ASSIST DEVICES

MDR report key: 2923559 · Received January 22, 2013

Report

Report Number
1531186-2013-00257
Date Received
January 22, 2013
Report Date
January 19, 2013
Manufacturer
PINGHU WEIFENG MATERIAL TECHNOLOGY
Product Code
IKX
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OH, US
Reporter Occupation
MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

Narratives

Description of Event or Problem · 1

PROVIDER STATES LEG BROKE ON SUCTION SECTION OF LEG.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
31310 DAILY ACTIVITY ASSIST DEVICES 890.5050 IKX PINGHU WEIFENG MATERIAL TECHNOLOGY UNKNOWN PW120401

Patients

Seq Age Sex Outcome Treatment
1 Other