BEUDAMED
    FDA Adverse Event Injury Summary report: N

    WALGREENS

    MDR report key: 5748572 · Received June 24, 2016

    Report

    Report Number
    2438477-2016-00024
    Event Type
    Injury
    Date Received
    June 24, 2016
    Date of Event
    March 25, 2016
    Report Date
    May 12, 2016
    Manufacturer
    RAISE MEDICAL INDUSTRIES, INC.
    Product Code
    KHY
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DRIVE MEDICAL RECEIVED A NOTICE OF INCIDENT WHICH INVOLVED A QUAD CANE THAT DRIVE MEDICAL HAS BEEN SOURCING FOR (B)(6). THE END USER WAS USING THE CANE WHILE GOING DOWN THE THREE WIDE CONCRETE STEPS OF THEIR PROPERTY. AS HE CAME TO THE BOTTOM STEP, ONE OF THE PRONGS OF THE CANE BENT INWARD. THE CANE TORE HIS LEG AS HE WAS FALLING. HIS LEFT LEG WAS ALLEGEDLY WOUNDED FROM KNEE TO HALF WAY DOWN HIS SHIN. THIS REPORT IS BASED SOLELY ON THE INFORMATION PROVIDED BY THE WIFE OF THE END USER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    401828 WALGREENS CANE KHY RAISE MEDICAL INDUSTRIES, INC. 271063

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Hospitalization| R