MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-10-18 for DRIVE 10257BL-1 manufactured by Hangzhou Fuyang Hongwei Metal Product Ltd Co.
| Report Number | 2438477-2019-00067 |
| MDR Report Key | 9207701 |
| Date Received | 2019-10-18 |
| Date of Report | 2019-10-18 |
| Date of Event | 2019-08-28 |
| Date Facility Aware | 2019-08-28 |
| Report Date | 2019-10-18 |
| Date Reported to FDA | 2019-10-18 |
| Date Reported to Mfgr | 2019-10-19 |
| Date Added to Maude | 2019-10-18 |
| 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 | DRIVE |
| Generic Name | ROLLATOR |
| Product Code | ITJ |
| Date Received | 2019-10-18 |
| Model Number | 10257BL-1 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | 3 YR |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | HANGZHOU FUYANG HONGWEI METAL PRODUCT LTD CO |
| Manufacturer Address | LIAOAN VILLAGE WANSHI TOWN FUYANG DISTRICT, 311406 CH 311406 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-10-18 |