Brand Name | RIFTON ACTIVITY CHAIR |
Type of Device | ACTIVITY CHAIR |
Manufacturer (Section D) |
RIFTON EQUIPMENT |
2255 platte clove rd. |
elka park, ny |
|
Manufacturer (Section G) |
RIFTON EQUIPMENT |
2255 platte clove rd. |
|
elka park, ny |
|
Manufacturer Contact |
travis
scott
|
103 woodcrest drive |
rifton, ny
|
6587722
|
|
MDR Report Key | 10086819 |
MDR Text Key | 209805222 |
Report Number | 1319558-2020-00007 |
Device Sequence Number | 1 |
Product Code |
INN
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor |
Reporter Occupation |
Administrator/Supervisor
|
Type of Report
| Initial |
Report Date |
05/26/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 05/26/2020 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Model Number | R860 |
Device Catalogue Number | R860 |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 05/08/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 06/29/2016 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Age | 15 YR |
Patient Weight | 70 |
|
|