BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 2993545 · Received March 7, 2013

    Report

    Report Number
    1525712-2013-01771
    Event Type
    Malfunction
    Date Received
    March 7, 2013
    Report Date
    February 11, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    KNN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(4). NO SERIOUS INJURY ALLEGED. MALFUNCTION ALLEGED. DEALER STATED THAT ON THE LEFT REAR SIDE, ONE OF THE PINS AS CAUSED A CRACK TO FORM ON THE BACK. MDR FILED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    96860 WHEELCHAIR COMPONENTS 890.3920 KNN INVACARE TAYLOR STREET PBD1830

    Patients

    Seq Age Sex Outcome Treatment
    1 Other