MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-07-20 for SURE GRIP ORTHO CANE RPM79030-BRZ W1448BR manufactured by Foshan Nanhai R. Poon Medical Products Co., Ltd..
[114802921]
End user was walking with a cane when the shaft snapped. There was no fall or injury.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1000282279-2018-00001 |
| MDR Report Key | 7706266 |
| Date Received | 2018-07-20 |
| Date of Report | 2018-07-20 |
| Date of Event | 2018-06-19 |
| Date Mfgr Received | 2018-07-12 |
| Date Added to Maude | 2018-07-20 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | KEVIN WALLS |
| Manufacturer Street | 33 GOLDEN EAGLE LANE |
| Manufacturer City | LITTLETON CO 80127 |
| Manufacturer Country | US |
| Manufacturer Postal | 80127 |
| Manufacturer Phone | 7209625412 |
| Manufacturer G1 | FOSHAN NANHAI R. POON MEDICAL PRODUCTS CO., LTD. |
| Manufacturer Street | NEW CITY DISTRICT DANZAO, NANHAI |
| Manufacturer City | FOSHAN, GUANGDONG 528216 |
| Manufacturer Country | CH |
| Manufacturer Postal Code | 528216 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | SURE GRIP ORTHO CANE |
| Generic Name | CANE |
| Product Code | IPS |
| Date Received | 2018-07-20 |
| Model Number | RPM79030-BRZ |
| Catalog Number | W1448BR |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | FOSHAN NANHAI R. POON MEDICAL PRODUCTS CO., LTD. |
| Manufacturer Address | NEW CITY DISTRICT DANZAO, NANHAI FOSHAN, GUANGDONG 528216 CH 528216 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-07-20 |