BEUDAMED
    FDA Adverse Event Injury Summary report: N

    NARROW BASE QUAD CANE 1616710022

    MDR report key: 5650852 · Received May 12, 2016

    Report

    Report Number
    1531186-2016-00012
    Event Type
    Injury
    Date Received
    May 12, 2016
    Report Date
    April 19, 2016
    Manufacturer
    PINGHU WEIFENG MATERIAL TECHNOLOGY
    Product Code
    KHY
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    FL, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER IS STATING THE FOLLOWING: THAT HE HAS A DEFECTIVE MODEL 3920-2, STATING THAT HE WAS WALKING WITH HIS WIFE IN THEIR NEIGHBORHOOD ON DRY LEVEL SIDEWALK WHEN FOR NO REASON THE FOUR PRONGED CANE CAME APART AND THE END USER FELL DOWN MAKING HIS WIFE FALL ON THE GROUND ALSO. END USER IS ALLEGING THAT HE HAD BRUISED RIBS FROM THE FALL. UPDATE FROM CONSUMER AFFAIRS ON 04/19/2016: END USER CALLED BACK AND SENT PHOTOS OF THE BROKEN CANE. THE DEALER PICKED UP THE CANE BUT DID NOT RETURN IT TO US AND LOCATION OF PRODUCT IS UNKNOWN AT THIS TIME. THEY THINK IT WAS THROWN AWAY WHEN THEY EXCHANGED IT. END USER SAID HE WAS JUST WALKING ALONG AND IT SNAPPED IN HALF AND HE FELL ON HIS WIFE. NO BROKEN BONES BUT HE WAS SORE AND HAD AN X-RAY DONE TO CONFIRM HE DID NOT BREAK ANYTHING. END USER HAD SORENESS AND BRUISING. NO FURTHER INFORMATION PROVIDED OR EXPECTED AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    305200 NARROW BASE QUAD CANE 1616710022 CANE KHY PINGHU WEIFENG MATERIAL TECHNOLOGY 3920-2

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Hospitalization