MAUDE Adverse Event Report: DANYANG MAXTHAI MEDICAL EQUIPMENT ECONOMY ROLLATOR RED WITH HAND BRAKES AND CURVED BACKREST 9153646615; WALKER, MECHANICAL

Model Number 65650R

Device Problems Out-Of-Box Failure (2311); Mechanical Jam (2983)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Type  malfunction  

Event Description

It has been reported by a dealer that the right front and rear wheels are not moving properly right out of the box.The dealer stated, the rear casters act like the brake is on, but nothing is touching the wheel.

• Brand Name: ECONOMY ROLLATOR RED WITH HAND BRAKES AND CURVED BACKREST 9153646615
• Type of Device: WALKER, MECHANICAL
• Manufacturer (Section D): DANYANG MAXTHAI MEDICAL EQUIPMENT; danyang ; CH
• MDR Report Key: 4365886
• MDR Text Key: 20781049
• Report Number: 1531186-2014-06867
• 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: Distributor
• Source Type: Invalid Data
• Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date: 12/24/2014,11/13/2014

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: 65650R
• 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: 12/24/2014
• Distributor Facility Aware Date: 11/13/2014
• Device Age: 6 MO
• Date Report to Manufacturer: 12/24/2014
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 12/29/2014
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other