BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DEMI FOLDING CANE

    MDR report key: 8119828 · Received November 30, 2018

    Report

    Report Number
    1056127-2018-00005
    Event Type
    Malfunction
    Date Received
    November 30, 2018
    Date of Event
    October 24, 2018
    Report Date
    November 28, 2018
    Manufacturer
    HOMECARE ENTERPRISE CO. LTD.
    Product Code
    IPS
    UDI-DI
    00754756130657
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA, US
    Reporter Occupation
    003

    Narratives

    Description of Event or Problem · 0

    BROKEN SHAFT.

    Description of Event or Problem · 1

    SHAFT BROKE. THERE IS NO FALL OR INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    961200 DEMI FOLDING CANE FOLDING CANE IPS HOMECARE ENTERPRISE CO. LTD. B012-606S-109S-S 00754756130657

    Patients

    Seq Age Sex Outcome Treatment
    1