BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDLINE BASIC ROLLATOR FOUR-WHEELED

    MDR report key: 6639583 · Received June 12, 2017

    Report

    Report Number
    MW5070389
    Event Type
    Injury
    Date Received
    June 12, 2017
    Date of Event
    March 20, 2017
    Manufacturer
    MEDLINE, INC.
    Product Code
    ITJ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NJ, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    DEAR SIR/MADAM: WE REPRESENT (B)(6). I AM ENCLOSING THE COMPLETED REPORT FOR YOUR REVIEW. PLEASE LET ME KNOW IF THERE IS ANYTHING ELSE YOU NEED. CORDIALLY, (B)(6). INCIDENT ADDRESS: (B)(6). INJURY, MEDICAL ATTENTION RECEIVED. INJURY, EMERGENCY DEPARTMENT TREATMENT RECEIVED. LOCATION OF INJURY: ELBOW. TYPE OF INJURY: BREAK, FRACTURE. (B)(6).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    416650 MEDLINE BASIC ROLLATOR FOUR-WHEELED ROLLING WALKER ITJ MEDLINE, INC. MD586850E

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Hospitalization