BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DONJOY

    MDR report key: 6741593 · Received July 25, 2017

    Report

    Report Number
    9616086-2017-00012
    Event Type
    Injury
    Date Received
    July 25, 2017
    Date of Event
    June 22, 2017
    Report Date
    July 25, 2017
    Manufacturer
    DJO, LLC
    Product Code
    ITQ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    COMPLAINT RECEIVED THAT ALLEGES "AS HE STARTED TO WALK HE TOOK FOUR STEPS AND THE CAPS CAUGHT UP AND LOCKED UP AND HINGES ALSO LOCKED UP ON HIM AND FELL. HE WAS ALSO HELPING A FRIEND PICK UP A BEER KEG AND HIS FRIEND SLOWED DOWN HE TOOK A STEP AND AGAIN THEY LOCKED HE FELL DOWN AND HIT HIS HEAD THE BEER KEG LANDED ON HIS FINGER HE WAS APPLIED WITH STITCHES .HE IS ALSO LIMITED ON CARING STUFF". QUESTIONNAIRE NOT RECEIVED FROM CLINICIAN AND/OR PATIENT. DEVICE NOT RETURNED TO MANUFACTURER FOR EVALUATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    522745 DONJOY OA NANO, LATERAL, LT, M ITQ DJO, LLC 11-1217-3

    Patients

    Seq Age Sex Outcome Treatment
    1 Other 11-1216-3, OA NANO, LATERAL, RT, M