MAUDE Adverse Event Report: UNKNOWN ECONOMY ROLLATOR RED WITH HAND BRAKES AND CURVED BACKREST 9153646615; WALKER, MECHANICAL

Model Number 65650R

Device Problem Unstable (1667)

Patient Problem Lymphoma (3263)

Event Type  malfunction  

Event Description

The dealer alleges the right brake handle is broken on a 65650r rollator.

• Brand Name: ECONOMY ROLLATOR RED WITH HAND BRAKES AND CURVED BACKREST 9153646615
• Type of Device: WALKER, MECHANICAL
• Manufacturer (Section D): UNKNOWN; OH
• MDR Report Key: 4482130
• MDR Text Key: 15241835
• Report Number: 1531186-2015-00773
• 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: 02/03/2015,01/28/2015

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: 02/03/2015
• Distributor Facility Aware Date: 01/28/2015
• Date Report to Manufacturer: 02/03/2015
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 02/04/2015
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other