BEUDAMED
    FDA Adverse Event Summary report: N

    DAILY ACTIVITY ASSIST DEVICES

    MDR report key: 4090428 · Received September 15, 2014

    Report

    Report Number
    1531186-2014-04120
    Date Received
    September 15, 2014
    Report Date
    August 22, 2014
    Manufacturer
    UNKNOWN
    Product Code
    IKX
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PER END-USER, STATES THE SUCTION CUP BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    568305 DAILY ACTIVITY ASSIST DEVICES 890.5050 IKX UNKNOWN 98071

    Patients

    Seq Age Sex Outcome Treatment
    1 Other