BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DAILY ACTIVITY ASSIST DEVICES

    MDR report key: 3110118 · Received May 13, 2013

    Report

    Report Number
    9616091-2013-00809
    Event Type
    Malfunction
    Date Received
    May 13, 2013
    Report Date
    April 16, 2013
    Manufacturer
    INVAMEX
    Product Code
    ILS
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATES THE ARM FELL OFF THE COMMODE AND BROKE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    210232 DAILY ACTIVITY ASSIST DEVICES 890.5050 ILS INVAMEX 9630-4

    Patients

    Seq Age Sex Outcome Treatment
    1 Other