BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUICKIE REVOLUTION WHEELCHAIR

    MDR report key: 235190 · Received August 10, 1999

    Report

    Report Number
    2082643-1999-00811
    Event Type
    Malfunction
    Date Received
    August 10, 1999
    Date of Event
    August 10, 1999
    Report Date
    August 10, 1999
    Manufacturer
    SUNRISE MEDICAL HDP
    Product Code
    IOR
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    SERVICE PERSONNEL

    Narratives

    Description of Event or Problem · 1

    REPORTER CLAIMS THE BACK FRAME BROKE AT THE PIVOT HOLE AREA WHILE CHAIR WAS IN USE. NO INJURIES INVOLVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKIE REVOLUTION WHEELCHAIR WHEELCHAIR,MECHANICAL IOR SUNRISE MEDICAL HDP NA P/N-840169

    Patients

    Seq Age Sex Outcome Treatment
    1 21 YR Other