Brand Name | DRIVE |
Type of Device | CANE |
Manufacturer (Section D) |
HOMECARE ENTERPRISE CO., LTD. |
5 lane 476 lunmei rd. |
changhua city |
changhua, 500 |
TW 500 |
|
MDR Report Key | 10063484 |
MDR Text Key | 191590815 |
Report Number | 2438477-2020-00028 |
Device Sequence Number | 1 |
Product Code |
IPS
|
UDI-Device Identifier | 00822383246451 |
UDI-Public | 822383246451 |
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Distributor
|
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
05/15/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Lay User/Patient
|
Device Model Number | RTL10372BK |
Was Device Available for Evaluation? |
No
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 05/15/2020 |
Distributor Facility Aware Date | 04/27/2020 |
Device Age | 17 MO |
Date Report to Manufacturer | 05/18/2020 |
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 05/15/2020 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Age | 74 YR |
Patient Weight | 86 |
|
|