BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ROLLATOR JR RED 9153641188

    MDR report key: 5153587 · Received October 15, 2015

    Report

    Report Number
    9615290-2015-00297
    Event Type
    Malfunction
    Date Received
    October 15, 2015
    Report Date
    September 22, 2015
    Manufacturer
    DOLOMITE AB
    Product Code
    ITJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE A SUPPLEMENTAL RECORD WILL BE FILED.

    Description of Event or Problem · 1

    BRAKE IS NOT HOLDING, POPPING UP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    685472 ROLLATOR JR RED 9153641188 WALKER, MECHANICAL ITJ DOLOMITE AB JAZZLOW

    Patients

    Seq Age Sex Outcome Treatment
    1