FDA Adverse Event
Summary report: N
DAILY ACTIVITY ASSIST DEVICES
MDR report key: 4200436
·
Received October 24, 2014
Report
- Report Number
- 1531186-2014-05074
- Date Received
- October 24, 2014
- Report Date
- September 29, 2014
- Manufacturer
- DAIGLER KUNSTSTOFFSPRITZEREI GMBH
- Product Code
- IKX
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Description of Event or Problem · 1
PER THE PROVIDER, THE UNIT'S LEG HAS BROKEN FROM THE SCREW.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 678180 | DAILY ACTIVITY ASSIST DEVICES | 890.5050 | IKX | DAIGLER KUNSTSTOFFSPRITZEREI GMBH | H112-5 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |