MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 04 report with the FDA on 2014-10-14 for QUICK CHANGE CRUTCH ADULT 9153618192 8115-A manufactured by Healthplus.
[5089705]
End user's wife advised her husband was walking and the plastic piece that holds the adjust bar slipped down on crutches and caused them to be wobbly. End user fell down the stairs onto the floor. No apparent injuries and no medical attention sought. End user is a recent amputee and goes to physical therapy who is made aware when he falls. They are unsure of model of crutch, but thinks it is the adjust.
Patient Sequence No: 1, Text Type: D, B5
[5173031]
End user's wife advised her husband was walking and the plastic piece that holds the adjust bar slipped down on crutches and caused them to be wobbly. End user fell down the stairs onto the floor. No apparent injuries and no medical attention sought. End user is a recent amputee and goes to physical therapy who is made aware when he falls. They are unsure of model of crutch, but thinks it is the adjust.
Patient Sequence No: 1, Text Type: D, B5
[12673301]
(b)(4) 2014 -- initial mfg report # 1525712-2014-06966 was submitted to the fda on 10/14/2014 as a manufacturer. Additional information has been obtained. With the knowledge of the actual manufacturer this is now an importer report, not a manufacturer, therefore, the correct fda registration # is (b)(4).
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1525712-2014-06966 |
| MDR Report Key | 4169086 |
| Report Source | 04 |
| Date Received | 2014-10-14 |
| Date of Report | 2014-09-25 |
| Date of Event | 2014-09-01 |
| Date Mfgr Received | 2014-09-25 |
| Date Added to Maude | 2014-10-27 |
| 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 | 3 |
| Reporter Occupation | PATIENT |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | KEVIN GUYTON |
| Manufacturer Street | ONE INVACARE WAY |
| Manufacturer City | ELYRIA OH 44035 |
| Manufacturer Country | US |
| Manufacturer Postal | 44035 |
| Manufacturer Phone | 8003336900 |
| Manufacturer G1 | HEALTHPLUS |
| Manufacturer City | HANDAN OH |
| Manufacturer Country | CH |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | QUICK CHANGE CRUTCH ADULT 9153618192 |
| Generic Name | TIPS AND PADS, CANE, CRUTCH AND WALKE |
| Product Code | IPR |
| Date Received | 2014-10-14 |
| Model Number | 8115-A |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | HEALTHPLUS |
| Manufacturer Address | HANDAN OH CH |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2014-10-14 |