BEUDAMED
    FDA Adverse Event Death Summary report: N

    418-OR-4

    MDR report key: 584075 · Received March 14, 2005

    Report

    Report Number
    3004499949-2005-00001
    Event Type
    Death
    Date Received
    March 14, 2005
    Date of Event
    April 1, 2003
    Report Date
    March 14, 2005
    Manufacturer
    MJM INTERNATIONAL CORP.
    Product Code
    ITJ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CONTACT CALLED EXPLAINING THAT THERE WOULD BE AN INCIDENT REPORT FILED FOR A WALKER. AT THAT TIME, CONTACT DID NOT HAVE ALL THE RIGHT INFORMATION. CONTACT SAID THEY WOULD SEND THE REPORT TO COMPANY WHEN IT WAS READY BY EITHER FAX OR MAIL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 418-OR-4 WALKER (MUST USE WITH ASSISTANCE) ITJ MJM INTERNATIONAL CORP. 418-OR-4 *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Death