Brand Name | BLUE ADULT ROLLATOR W/BASKET 9153650332 |
Type of Device | WALKER, MECHANICAL |
Manufacturer (Section D) |
CONSMA |
no. 158 huicheng rd |
huimin ind |
jianshan zhejiang |
CH |
|
MDR Report Key | 4407103 |
MDR Text Key | 5309471 |
Report Number | 1531186-2015-00176 |
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 |
01/09/2015,12/22/2014 |
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 | 65851B |
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 | 01/09/2015 |
Distributor Facility Aware Date | 12/22/2014 |
Date Report to Manufacturer | 01/09/2015 |
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 01/12/2015 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
|
|