BEUDAMED
    FDA Adverse Event Summary report: N

    MECHANICAL WALKER, ROLLATOR

    MDR report key: 3071866 · Received April 22, 2013

    Report

    Report Number
    1531186-2013-01677
    Date Received
    April 22, 2013
    Report Date
    March 26, 2013
    Manufacturer
    UNKNOWN
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(4). NO SERIOUS INJURY ALLEGED. MALFUNCTION ALLEGED. DEALER STATED THAT THE RIGHT SIDE BREAK PAD IS MISSING OFF THE BRAKE ASSEMBLY. MDR FILED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    171636 MECHANICAL WALKER, ROLLATOR 890.3825 ITJ UNKNOWN 66550

    Patients

    Seq Age Sex Outcome Treatment
    1 Other