BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FEATHERLIGHT TRANSPORT CHAIR

    MDR report key: 1849599 · Received September 28, 2010

    Report

    Report Number
    1056127-2010-00005
    Event Type
    Malfunction
    Date Received
    September 28, 2010
    Date of Event
    August 29, 2010
    Report Date
    September 28, 2010
    Manufacturer
    APEX MEDICAL CORP.
    Product Code
    INN
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    REAR TIRE OF TRANSPORT CHAIR STARTED TO COME APART BUT PT CONTINUED TO USE IT. SHE WAS SITTING IN CHAIR WHEN TIRE FINALLY GAVE WAY CAUSING THE CHAIR TO TILT AND SHE FELL OUT. SHE SUFFERED A BLOOD BLISTER ON ARM ONLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FEATHERLIGHT TRANSPORT CHAIR TRANSPORT CHAIR INN APEX MEDICAL CORP. H3005

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR