MAUDE MDR 4169086

MDR report key
4169086
Report number
1525712-2014-06966
Event key
0
Event type
3
Date of event
2014-09-01
Date received
2014-10-14
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
305
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
KEVIN GUYTON
Address
ONE INVACARE WAY ELYRIA OH 44035 US
Phone
800-800-8003
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1QUICK CHANGE CRUTCH ADULT 9153618192TIPS AND PADS, CANE, CRUTCH AND WALKEHEALTHPLUSIPR8115-AR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-10-1401. O

Event Narratives#

D

Patient 1

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.

D

Patient 1

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.

N

Patient 1

(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).