BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3073570 · Received April 23, 2013

    Report

    Report Number
    9615350-2013-00008
    Event Type
    Malfunction
    Date Received
    April 23, 2013
    Report Date
    March 26, 2013
    Manufacturer
    MOTION CONCEPTS
    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

    DEALER STATED THAT THE THREADED SCREW THAT COMES OUT OF BACK ITSELF AND ATTACHES TO BACK CANE MOUNTING HARDWARE IS OFF OF BACK AND ACTUALLY RATTLING INSIDE THE BACK ITSELF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    175345 WHEELCHAIR COMPONENTS 890.3920 KNN MOTION CONCEPTS MPB18

    Patients

    Seq Age Sex Outcome Treatment
    1 Other