BEUDAMED
    FDA Adverse Event Summary report: N

    DAILY ACTIVITY ASSIST DEVICES

    MDR report key: 3013819 · Received March 20, 2013

    Report

    Report Number
    1531186-2013-01177
    Date Received
    March 20, 2013
    Date of Event
    February 20, 2013
    Report Date
    February 22, 2013
    Manufacturer
    UNKNOWN
    Product Code
    ILS
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(4). NO SERIOUS INJURY ALLEGED. MALFUNCTION ALLEGED. PROVIDER STATES THE PATIENT WAS USING THE COMMODE AND THE LEG BROKE CAUSING THE PATIENT TO FALL TO THE GROUND. THE PATIENT DID NOT GET HURT. MDR FILED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    115807 DAILY ACTIVITY ASSIST DEVICES 890.5050 ILS UNKNOWN 6500-BHD

    Patients

    Seq Age Sex Outcome Treatment
    1 Other