BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE MEDICAL

    MDR report key: 6018916 · Received October 11, 2016

    Report

    Report Number
    2438477-2016-00047
    Event Type
    Injury
    Date Received
    October 11, 2016
    Date of Event
    September 1, 2016
    Report Date
    September 11, 2016
    Manufacturer
    JAN MAO INDUSTRIES CO., LTD
    Product Code
    IPS
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    Narratives

    Description of Event or Problem · 1

    DRIVE DEVILBISS HEALTHCARE RECEIVED NOTICE REGARDING THE INCIDENT FROM THE ENDUSER'S HUSBAND, INVOLVING A CANE, A PRODUCT IMPORTED AND DISTRIBUTED BY DRIVE DEVILBISS HEALTHCARE. WHILE USING THE CANE, THE HANDLE OF THE CANE BROKE CAUSING HER TO ALLEGEDLY JAM HER WRIST INTO THE STEM OF THE CANE. AN X-RAY WAS TAKEN WHICH SHOWED THAT HER WRIST WAS FRACTURED. A CAST WAS PUT ON AND IT WILL REMAIN IN PLACE FOR AT LEAST SIX WEEKS. THIS REPORT IS BASED ON THE INFORMATION THAT WAS PROVIDED BY THE ENDUSER'S HUSBAND.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    669739 DRIVE MEDICAL CANE IPS JAN MAO INDUSTRIES CO., LTD 10339R-1

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Required Intervention