BEUDAMED
    FDA Adverse Event Summary report: N

    MECHANICAL WALKER, ROLLATOR

    MDR report key: 3230143 · Received July 16, 2013

    Report

    Report Number
    1531186-2013-03187
    Date Received
    July 16, 2013
    Report Date
    June 25, 2013
    Manufacturer
    R. POON
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE PROVIDER STATED A BOLT BROKE OFF ON THE WHEEL CAUSING THE WHEEL TO COME OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    328810 MECHANICAL WALKER, ROLLATOR 890.3825 ITJ R. POON 66500

    Patients

    Seq Age Sex Outcome Treatment
    1 Other