Brand Name | BEACTIVE PLUS |
Type of Device | ORTHOSIS, LIMB, FOR BACK PAIN |
Manufacturer (Section D) |
NATURES PILLOWS, INC. AND TOP DOG DIRECT, LLC |
|
|
MDR Report Key | 16051268 |
MDR Text Key | 306341042 |
Report Number | MW5114005 |
Device Sequence Number | 1 |
Product Code |
PMV
|
Combination Product (y/n) | N |
Reporter Country Code | CA |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Voluntary
|
Reporter Occupation |
Patient
|
Type of Report
| Initial |
Report Date |
12/07/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Was Device Available for Evaluation? |
Yes
|
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 12/23/2022 |
Patient Sequence Number | 1 |
Patient Age | 53 YR |
Patient Sex | Male |
Patient Weight | 91 KG |
Patient Ethnicity | Non Hispanic |
Patient Race | White |
|
|