MAUDE Adverse Event Report: JAN MAO MECHANICAL WALKER, ROLLATOR; 890.3825

Model Number 6441-A

Device Problem Sticking (1597)

Patient Problem No Patient Involvement (2645)

Event Type  No Answer Provided  

Event Description

Dealer stated that the 5" caster wheels for the 6441-a walker stick, they do not free wheel at all.

• Brand Name: MECHANICAL WALKER, ROLLATOR
• Type of Device: 890.3825
• Manufacturer (Section D): JAN MAO; huizhou ; CH
• MDR Report Key: 4212551
• MDR Text Key: 5153248
• Report Number: 1531186-2014-05211
• Device Sequence Number: 1
• Product Code: ITJ
• 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: 10/30/2014,10/08/2014

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
• Device Operator: Lay User/Patient
• Device Model Number: 6441-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: 10/30/2014
• Distributor Facility Aware Date: 10/08/2014
• Date Report to Manufacturer: 10/30/2014
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 10/30/2014
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other