DR COMFORT LANA CC BLACK 11 M/W 110910-MW-11.0

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 2019-10-24 for DR COMFORT LANA CC BLACK 11 M/W 110910-MW-11.0 manufactured by Djo, Llc.

MAUDE Entry Details

Report Number3008579854-2019-00014
MDR Report Key9232829
Report SourceCONSUMER
Date Received2019-10-24
Date of Report2019-10-23
Date of Event2019-09-30
Date Mfgr Received2019-09-30
Date Added to Maude2019-10-24
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 G1DR. COMFORT, A DJO, LLC COMPANY
Manufacturer Street10300 ENTERPRISE DR.
Manufacturer CityMEQUON WI 59092
Manufacturer CountryUS
Manufacturer Postal Code59092
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDR COMFORT LANA CC BLACK 11 M/W
Generic NameORTHOSIS, CORRECTIVE SHOE
Product CodeKNP
Date Received2019-10-24
Model Number110910-MW-11.0
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerDJO, LLC
Manufacturer Address1430 DECISION STREET VISTA CA 920819663 US 920819663


Patients

Patient NumberTreatmentOutcomeDate
10 2019-10-24

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