BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE MEDICAL

    MDR report key: 3072281 · Received April 19, 2013

    Report

    Report Number
    2438477-2013-00010
    Event Type
    Injury
    Date Received
    April 19, 2013
    Date of Event
    January 18, 2013
    Report Date
    March 22, 2013
    Manufacturer
    HL CORP (SHENZHEN)
    Product Code
    IPS
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    DRIVE MEDICAL HAS REC'D A SUMMONS FROM CLAIMANT'S ATTORNEY COMPLAINING ABOUT AN INCIDENT INVOLVING A LARGE BASE QUAD CANE ALLEGEDLY IMPORTED AND DISTRIBUTED BY DRIVE MEDICAL. THE ATTORNEY LETTER STATED THAT THE CLAIMANT WAS USING THE QUAD CANE AT HOME WHEN IT ALLEGEDLY BROKE IN HALF CAUSING HIM TO FALL. THE CLAIMANT SUSTAINED A CRACKED FEMUR, BROKEN PATELLA AND BROKEN BALL JOINT IN HIP. THIS MDR REPORT IS BASED ON A CLAIMANT'S ATTORNEY STATEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    169302 DRIVE MEDICAL CANE (PRODUCT CODE: IPS) IPS HL CORP (SHENZHEN) 10385-4 (POSSIBLE) NA

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Required Intervention