BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3011796 · Received March 19, 2013

    Report

    Report Number
    9615350-2013-00005
    Event Type
    Malfunction
    Date Received
    March 19, 2013
    Report Date
    February 20, 2013
    Manufacturer
    MOTION CONCEPTS
    Product Code
    KNN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES THE BACK SHELL IS CRACKED AND HARDWARE IS FALLING OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    115070 WHEELCHAIR COMPONENTS 890.3920 KNN MOTION CONCEPTS MPB1616

    Patients

    Seq Age Sex Outcome Treatment
    1 Other