BEUDAMED
    FDA Adverse Event Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3123070 · Received May 21, 2013

    Report

    Report Number
    1531186-2013-02180
    Date Received
    May 21, 2013
    Report Date
    April 25, 2013
    Manufacturer
    UNKNOWN
    Product Code
    KNN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES FOOTPLATE BROKE ON FOOTREST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    224757 WHEELCHAIR COMPONENTS 890.3920 KNN UNKNOWN T93HE

    Patients

    Seq Age Sex Outcome Treatment
    1 Other