BEUDAMED
    FDA Adverse Event Summary report: N

    MECHANICAL WALKER, ROLLATOR

    MDR report key: 3123083 · Received May 21, 2013

    Report

    Report Number
    1531186-2013-02188
    Date Received
    May 21, 2013
    Report Date
    April 24, 2013
    Manufacturer
    CONSMA
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES THE RIGHT FRONT FORK ON A 65851R ROLLATOR PULLED OUT OF THE FRAME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    224856 MECHANICAL WALKER, ROLLATOR 890.3825 ITJ CONSMA 65851R

    Patients

    Seq Age Sex Outcome Treatment
    1 Other