MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2000-04-10 for CRUTCH, FORMEARM ALUMINUMTALL A MDS805160 * manufactured by Medline Industries, Inc..
[178818]
Reportedly, the lock button on the forearm crutches gave way and they collapsed. Unknown who the mfr of the crutches is. Consequences to user are unknown user is not cooperative.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1417592-2000-00010 |
| MDR Report Key | 273392 |
| Report Source | 08 |
| Date Received | 2000-04-10 |
| Date of Report | 2000-04-07 |
| Date Facility Aware | 2000-03-13 |
| Report Date | 2000-04-07 |
| Date Reported to FDA | 2000-08-03 |
| Date Mfgr Received | 2000-03-14 |
| Date Added to Maude | 2000-04-14 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | LARA SIMMONS |
| Manufacturer Street | ONE MEDLINE PL |
| Manufacturer City | MUNDELEIN IL 60060 |
| Manufacturer Country | US |
| Manufacturer Postal | 60060 |
| Manufacturer Phone | 8479492639 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CRUTCH, FORMEARM ALUMINUMTALL A |
| Generic Name | CRUTCH |
| Product Code | IRP |
| Date Received | 2000-04-10 |
| Model Number | MDS805160 |
| Catalog Number | * |
| Lot Number | * |
| ID Number | * |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | UNKNOWN |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 264655 |
| Manufacturer | MEDLINE INDUSTRIES, INC. |
| Manufacturer Address | ONE MEDLINE PL. MUNDELEIN IL 60060 US |
| Baseline Brand Name | CRUTCH, FORMEARM ALUMINUMTALL A |
| Baseline Generic Name | CRUTCH |
| Baseline Model No | MDS805160 |
| Baseline Catalog No | * |
| Baseline ID | * |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2000-04-10 |