DONJOY FULLFORCE,ACL,SHRT CF,LT,XS 11-3221-1

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2019-06-26 for DONJOY FULLFORCE,ACL,SHRT CF,LT,XS 11-3221-1 manufactured by Djo, Llc.

MAUDE Entry Details

Report Number9616086-2019-00032
MDR Report Key8734873
Report SourceCONSUMER
Date Received2019-06-26
Date of Report2019-06-25
Date of Event2017-08-18
Date Mfgr Received2018-03-07
Device Manufacturer Date2017-07-12
Date Added to Maude2019-06-26
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Manufacturer ContactMR. BRIAN BECKER
Manufacturer Street2900 LAKE VISTA DRIVE
Manufacturer CityLEWISVILLE TX 75067
Manufacturer CountryUS
Manufacturer Postal75067
Manufacturer G1DJ ORTHOPEDICS DE MEXICO, S.A. DE C.V.
Manufacturer StreetCARRETERA LIBRE TIJUANA TECATE 20230 SUBMETROPOLI EL FLORIDO
Manufacturer CityTIJUANA, B.C. 22244,
Manufacturer CountryMX
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDONJOY FULLFORCE,ACL,SHRT CF,LT,XS
Generic NameJOINT, KNEE, EXTERNAL BRACE
Product CodeITQ
Date Received2019-06-26
Returned To Mfg2018-04-16
Model Number11-3221-1
Lot Number071217
OperatorLAY USER/PATIENT
Device AvailabilityR
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerDJO, LLC
Manufacturer Address1430 DECISION STREET VISTA CA 920819663 US 920819663


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2019-06-26

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