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 | 16061124 |
MDR Text Key | 308545894 |
Report Number | 1319061-2022-00006 |
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 |
Distributor |
Reporter Occupation |
505
|
Type of Report
| Initial |
Report Date |
12/28/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 12/28/2022 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Model Number | K320 |
Device Catalogue Number | K320 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 12/12/2022 |
Date Manufacturer Received | 11/28/2022 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/02/2015 |
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 | 80 YR |
Patient Sex | Female |
Patient Weight | 59 KG |