Brand Name | RIFTON TRAM |
Type of Device | TRANSFER AND MOBILITY DEVICE |
Manufacturer (Section D) |
RIFTON EQUIPMENT |
103 woodcrest drive |
rifton NY 12471 |
|
Manufacturer (Section G) |
RIFTON EQUIPMENT |
103 woodcrest drive |
|
rifton NY 12471 |
|
Manufacturer Contact |
travis
scott
|
103 woodcrest drive |
rifton, NY 12471
|
8456587722
|
|
MDR Report Key | 12748860 |
MDR Text Key | 280094086 |
Report Number | 1319061-2021-00013 |
Device Sequence Number | 1 |
Product Code |
FSA
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Consumer |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
11/05/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 11/03/2021 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Model Number | K310 |
Device Catalogue Number | K310 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 10/04/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 05/14/2019 |
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 | 23 YR |
Patient Sex | Female |
Patient Weight | 107 KG |
|
|