BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE ROLLER WALKER

    MDR report key: 8955757 · Received August 30, 2019

    Report

    Report Number
    MW5089494
    Event Type
    Injury
    Date Received
    August 30, 2019
    Date of Event
    August 13, 2019
    Report Date
    August 30, 2019
    Manufacturer
    DRIVE DEVILBISS HEALTHCARE / MEDICAL DEPOT, INC.
    Product Code
    ITJ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    UT, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    SUBMITTER WAS USING THE PRODUCT IN HER BACK YARD. OUT OF NOWHERE THE BACK LEFT LEG OF THE WALKER BROKE AND CAUSED THE SUBMITTER TO FALL. DID NOT SUSTAIN ANY MAJOR INJURIES. MINOR CUTS AND BRUISES ON THE ARMS AND LEGS. SUBMITTER BELIEVES THIS PRODUCT IS A FALL HAZARD. PURCHASE DATE: (B)(6) 2014 - THIS DATE IS AN ESTIMATE. DOCUMENT NUMBER: (B)(6). REPORT NUMBER: (B)(6).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    746208 DRIVE ROLLER WALKER WALKER MECHANICAL ITJ DRIVE DEVILBISS HEALTHCARE / MEDICAL DEPOT, INC. ROLLER WALKER

    Patients

    Seq Age Sex Outcome Treatment
    1