MAUDE Adverse Event Report: JAN MAO INDUSTRIAL CO., LTD HURRYCANE

Model Number HURRYCANE C2

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Death (1802); Fall (1848)

Event Date 04/01/2017

Event Type  Death  

Event Description

Drive devilbiss healthcare received notice about this claim from the enduser's wife, involving a cane, a product imported and distributed by drive devilbiss healthcare.While using the cane the enduser's foot allegedly got caught on the base of the cane causing him to fall.The wife doesn't believe that the cane was broken.She states that he was already beginning to demise as he is suffering from stage 4 bone cancer.After the fall he was in a lot of pain and he had started hospice care.He eventually passed away 2 weeks later.The cane was later thrown out.This report is based on the information that was provided by the enduser's wife.

• Brand Name: HURRYCANE
• Type of Device: CANE
• Manufacturer (Section D): JAN MAO INDUSTRIAL CO., LTD; pingguo county industrial zone; baise city; guangxi, 53140 0; CH 531400
• MDR Report Key: 6596152
• MDR Text Key: 76127847
• Report Number: 2438477-2017-00050
• Device Sequence Number: 1
• Product Code: IPS
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Distributor
• Reporter Occupation: Patient Family Member or Friend
• Type of Report: Initial
• Report Date: 05/26/2017,04/26/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/26/2017
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Lay User/Patient
• Device Model Number: HURRYCANE C2
• 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: 05/26/2017
• Distributor Facility Aware Date: 04/26/2017
• Event Location: Home
• Date Report to Manufacturer: 05/26/2017
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Outcome(s): Death
• Patient Age: 87 YR
• Patient Weight: 68