MAUDE Adverse Event Report: VIVE HEALTH VIVE HEALTH LLC; KNEE WALKER MOB1007

Model Number	MOB1007
Medical Device Problem Code	Mechanical Problem (1384)
Health Effect - Clinical Code	Hemorrhage/Blood Loss/Bleeding (1888)
Date of Event	10/21/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
The company already replaced the faulty unit with one in stock, she was about to use the knee walker until the breaks fail and she felt down, when his husband try to pick her up and see what happened he end also falling dow.They decide not going into the hr but she has bruises.

• Brand Name: VIVE HEALTH LLC
• Common Device Name: KNEE WALKER MOB1007
• Manufacturer (Section D): VIVE HEALTH; 8955 fontana del sol way; naples FL 34109
• MDR Report Key: 21241183
• Report Number: 3011191255-2025-10003
• Device Sequence Number: 18280647
• Product Code: ITJ
• UDI-Device Identifier: 00818323024937
• UDI-Public: 00818323024937
• Combination Product (Y/N): N
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Importer
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 01/23/2025
• Report Date (Section F): 01/23/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Model Number: MOB1007
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 10/21/2024
• Device Age: 1 YR
• Event Location: Home
• Date Report to Manufacturer: 12/18/2024
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 01/27/2025
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Female
• Date Report Sent to FDA: 01/23/2025