BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE MEDICAL

    MDR report key: 3030192 · Received March 27, 2013

    Report

    Report Number
    2438477-2013-00008
    Event Type
    Injury
    Date Received
    March 27, 2013
    Date of Event
    October 14, 2012
    Report Date
    February 28, 2013
    Manufacturer
    JINHUA TWINSTAR TOOLS CO. LTD.
    Product Code
    IKX
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    (B)(4) HAS RECEIVED AN ATTORNEY LETTER FROM (B)(6), ALLEGING AN INCIDENT INVOLVING A SUCTION CUP GRAB BAR ALLEGEDLY IMPORTED AND DISTRIBUTED BY (B)(4). IT IS ALLEGED THAT THE CLAIMANT WAS ATTEMPTING TO BATHE HIMSELF WITH ASSISTANCE OF THE GRAB BAR WHEN THE GRAB BAR FELL CAUSING HIM TO SLIP AND FALL RESULTING IN THREE (3) BROKEN RIBS AND A PUNCTURED LUNG. THIS MDR REPORT IS BASED ON THE INFORMATION PROVIDED BY THE CLAIMANT'S ATTORNEY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    125265 DRIVE MEDICAL SUCTION CUP GRAB BAR IKX JINHUA TWINSTAR TOOLS CO. LTD. 13082 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Required Intervention