FDA Adverse Event
Malfunction
Summary report: N
DAILY ACTIVITY ASSIST DEVICES
MDR report key: 4231286
·
Received November 6, 2014
Report
- Report Number
- 3007231105-2014-00085
- Event Type
- Malfunction
- Date Received
- November 6, 2014
- Report Date
- October 20, 2014
- Manufacturer
- UNKNOWN
- Product Code
- ILS
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IL, US
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Description of Event or Problem · 1
PROVIDER STATES THAT THE PATIENT FELL WHILE TRANSFERRING TO COMMODE AND BENT THE BACK LEGS OF THE COMMODE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 715439 | DAILY ACTIVITY ASSIST DEVICES | 890.5050 | ILS | UNKNOWN | 9630-1 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |