BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SURE GRIP ORTHO CANE

    MDR report key: 7682263 · Received July 12, 2018

    Report

    Report Number
    1056127-2018-00002
    Event Type
    Malfunction
    Date Received
    July 12, 2018
    Date of Event
    June 19, 2018
    Report Date
    June 19, 2018
    Manufacturer
    R. POON MEDICAL PRODUCTS COMPANY LTD
    Product Code
    IPS
    UDI-DI
    00754756914530
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    HOME MEDICAL EQUIPMENT DEALER REFUSED INFORMATION REGARDING PATIENT BASED ON HER UNDERSTANDING OF HIPPA .

    Description of Event or Problem · 1

    END USER WAS WALKING WITH A CANE WHEN THE SHAFT SNAPPED. THERE WAS NO FALL OR INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    526077 SURE GRIP ORTHO CANE CANE IPS R. POON MEDICAL PRODUCTS COMPANY LTD RPM79030-BRZ 00754756914530

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR