FDA Adverse Event
Malfunction
Summary report: N
WHEELCHAIR COMPONENTS
MDR report key: 3033982
·
Received April 3, 2013
Report
- Report Number
- 9616091-2013-00555
- Event Type
- Malfunction
- Date Received
- April 3, 2013
- Report Date
- March 7, 2013
- Manufacturer
- UNKNOWN
- 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. PROVIDER STATES LEVER IS STUCK AND WILL NOT ALLOW LEGREST TO GO UP AND DOWN. MDR FILED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 137076 | WHEELCHAIR COMPONENTS | 890.3920 | KNN | UNKNOWN | T94HE |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |