BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE MEDICAL

    MDR report key: 3049958 · Received April 5, 2013

    Report

    Report Number
    2438477-2013-00009
    Event Type
    Injury
    Date Received
    April 5, 2013
    Date of Event
    September 12, 2012
    Report Date
    November 20, 2012
    Manufacturer
    HOMECARE ENTERPRISE CO, LTD
    Product Code
    KMN
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    FL, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    (B)(4) HAS RECEIVED A LETTER FROM CLAIMANT'S ATTORNEY ABOUT AN INCIDENT INVOLVING A BATH BENCH ALLEGEDLY IMPORTED AND DISTRIBUTED BY (B)(4). CLAIMANT'S ATTORNEY STATED CLAIMANT WAS USING THE BATH BENCH WHEN IT COLLAPSED. CLAIMANT STRUCK HIS HEAD AGAINST THE SHOWER WALL AND CAUSED A BRAIN INJURY. THIS MDR REPORT IS BASED ON A CLAIMANT'S ATTORNEY STATEMENT AND INFORMATION PROVIDED BY (B)(4) ATTORNEY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    139781 DRIVE MEDICAL BATH BENCH KMN HOMECARE ENTERPRISE CO, LTD 12486 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Required Intervention