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.
| Report Number | 9616086-2019-00032 |
| MDR Report Key | 8734873 |
| Report Source | CONSUMER |
| Date Received | 2019-06-26 |
| Date of Report | 2019-06-25 |
| Date of Event | 2017-08-18 |
| Date Mfgr Received | 2018-03-07 |
| Device Manufacturer Date | 2017-07-12 |
| Date Added to Maude | 2019-06-26 |
| 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 | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. BRIAN BECKER |
| Manufacturer Street | 2900 LAKE VISTA DRIVE |
| Manufacturer City | LEWISVILLE TX 75067 |
| Manufacturer Country | US |
| Manufacturer Postal | 75067 |
| Manufacturer G1 | DJ ORTHOPEDICS DE MEXICO, S.A. DE C.V. |
| Manufacturer Street | CARRETERA LIBRE TIJUANA TECATE 20230 SUBMETROPOLI EL FLORIDO |
| Manufacturer City | TIJUANA, B.C. 22244, |
| Manufacturer Country | MX |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | DONJOY FULLFORCE,ACL,SHRT CF,LT,XS |
| Generic Name | JOINT, KNEE, EXTERNAL BRACE |
| Product Code | ITQ |
| Date Received | 2019-06-26 |
| Returned To Mfg | 2018-04-16 |
| Model Number | 11-3221-1 |
| Lot Number | 071217 |
| Operator | LAY USER/PATIENT |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DJO, LLC |
| Manufacturer Address | 1430 DECISION STREET VISTA CA 920819663 US 920819663 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-06-26 |