BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IMMERSION HYDROBATH

    MDR report key: 3020117 · Received March 25, 2013

    Report

    Report Number
    1525712-2013-02240
    Event Type
    Malfunction
    Date Received
    March 25, 2013
    Report Date
    February 28, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ILJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). RMA (B)(4) HAS BEEN INITIATED FOR THIS ISSUE. THE MALFUNCTION HAS NOT BEEN CONFIRMED.

    Description of Event or Problem · 1

    PROVIDER STATES (B)(4) MIXING VALVE BROKEN SPRAYING WATER ALL OVER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    121791 IMMERSION HYDROBATH 890.5100 ILJ INVACARE TAYLOR STREET IH3602GXL

    Patients

    Seq Age Sex Outcome Treatment
    1 Other