MAUDE Adverse Event Report: RALON MEDICAL EQUIPMENT CO. LTD. DAILY ACTIVITY ASSIST DEVICES; 890.5050

Model Number 6599

Device Problem Unstable (1667)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Type  No Answer Provided  

Event Description

Dealer states left side drop arm will not pull up and lock into place.

• Brand Name: DAILY ACTIVITY ASSIST DEVICES
• Type of Device: 890.5050
• Manufacturer (Section D): RALON MEDICAL EQUIPMENT CO. LTD.; xilian development zone; jinsha, danzao town 5282 22; CH 528222
• MDR Report Key: 4217897
• MDR Text Key: 17989148
• Report Number: 1531186-2014-05268
• Device Sequence Number: 1
• Product Code: ILS
• 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: 10/31/2014,10/14/2014

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: 6599
• 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: 10/31/2014
• Distributor Facility Aware Date: 10/14/2014
• Device Age: 10 MO
• Date Report to Manufacturer: 10/31/2014
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 10/31/2014
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other