BEUDAMED
    FDA Adverse Event Summary report: N

    MECHANICAL WALKER, ROLLATOR

    MDR report key: 3960859 · Received July 28, 2014

    Report

    Report Number
    1531186-2014-02787
    Date Received
    July 28, 2014
    Report Date
    June 20, 2014
    Manufacturer
    HL CORP. (SHENZHEN)
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PER END-USER, FORK BROKE, CAUSING THE USER TO FALL; THERE WERE NO INJURIES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    437819 MECHANICAL WALKER, ROLLATOR 890.3825 ITJ HL CORP. (SHENZHEN) 65850

    Patients

    Seq Age Sex Outcome Treatment
    1 Other