BEUDAMED
    FDA Adverse Event Summary report: N

    CANES

    MDR report key: 4222808 · Received November 4, 2014

    Report

    Report Number
    1531186-2014-05330
    Date Received
    November 4, 2014
    Report Date
    October 15, 2014
    Manufacturer
    UNKNOWN
    Product Code
    IPS
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    ENDUSER STATES THE LEG IS BENT. REFERRED ENDUSER TO PROVIDER WHERE PURCHASED TO DETERMINE IF THERE IS A DEFECT. ENDUSER STATES HAS HAD THE MODEL 3920 QUAD CANE SINCE (B)(6) 2013. ENDUSER IS AWARE MAY NOT BE WARRANTY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    706767 CANES 890.3075 IPS UNKNOWN 3920-1

    Patients

    Seq Age Sex Outcome Treatment
    1 Other