D
Patient 1
PT ALLEGES SHE WAS SITTING IN ROLLATOR IN LINE AT THE FOOD STAMP OFFICE WHEN THE WHEEL CAME OFF. SHE REPORTS THAT SHE FELL AND BROKE HER SHOULDER.
MAUDE MDR 1547594
- MDR report key
- 1547594
- Report number
- 3005009085-2009-00001
- Event key
- 0
- Event type
- 3
- Date of event
- 2009-09-24
- Date received
- 2009-11-23
- Adverse event
- 3
- Product problem
- 3
- Patients in event
- 0
- Reporter occupation
- 0
- Health professional
- 3
- Initial report to FDA
- 3
- Event location
- 0
Manufacturer Contact#
- Contact
- TED DEINARD, OFFICER
- Address
- PO BOX 66738 ST. LOUIS MO 63166 US
- Phone
- 877-877-8772
- Report source
- M
- Manufacturer link flag
- Y
Devices#
| Seq | Brand | Generic | Manufacturer | Product code | Model | Catalog | Lot | PMA | 510(k) | Implant | Evaluated | Availability |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ACCESS POINT MEDICAL | ROLLATOR | ACCESS POINT MEDICAL | ITJ | RL10040A-RD | R | N |
Patients#
| Sequence | Received | Treatment | Outcome |
|---|---|---|---|
| 1 | 2009-11-23 | 0 | 1. O |
Event Narratives#
N
Patient 1
IF PRODUCT IS RETURNED OR ADDITIONAL INFO IS RECEIVED, WE WILL SUBMIT AN UPDATED MDR REPORT AT THAT TIME.