MAUDE Adverse Event Report: JAN MAO CRUTCH; 890.3150

Model Number 8153-A

Device Problem Unstable (1667)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 04/17/2014

Event Type  No Answer Provided  

Event Description

Per provider handle on the crutch is loose.

• Brand Name: CRUTCH
• Type of Device: 890.3150
• Manufacturer (Section D): JAN MAO; huizhou ; CH
• MDR Report Key: 3843896
• MDR Text Key: 4657103
• Report Number: 1531186-2014-02037
• Device Sequence Number: 1
• Product Code: IPR
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Invalid Data
• Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date: 05/30/2014,04/17/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/02/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: 8153-A
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: Yes
• Date Report Sent to FDA: 05/30/2014
• Distributor Facility Aware Date: 04/17/2014
• Device Age: 2 YR
• Date Report to Manufacturer: 05/30/2014
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other
• Patient Age: 75 YR
• Patient Weight: 68