MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 99 report with the FDA on 2014-07-28 for HURRYCANE 04297-3-R manufactured by Ningo Liming Metal Products Co..
[20364962]
Customer reported she fell and broke her leg in 2 places and alleges that the cane collapsed which caused her fall. It is unk if there were any witnesses.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3009198231-2014-00002 |
| MDR Report Key | 4575259 |
| Report Source | 99 |
| Date Received | 2014-07-28 |
| Date of Report | 2014-07-24 |
| Date of Event | 2014-01-16 |
| Date Facility Aware | 2014-06-02 |
| Report Date | 2014-07-24 |
| Date Reported to Mfgr | 2014-06-02 |
| Device Manufacturer Date | 2013-01-01 |
| Date Added to Maude | 2015-03-09 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HURRYCANE |
| Generic Name | WALKING CANE |
| Product Code | KHY |
| Date Received | 2014-07-28 |
| Model Number | 04297-3-R |
| Lot Number | 1140 |
| Operator | OTHER |
| Device Availability | N |
| Device Age | 6 MO |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | NINGO LIMING METAL PRODUCTS CO. |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2014-07-28 |