BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3129937 · Received May 24, 2013

    Report

    Report Number
    9615350-2013-00010
    Event Type
    Malfunction
    Date Received
    May 24, 2013
    Report Date
    April 29, 2013
    Manufacturer
    MOTION CONCEPTS
    Product Code
    KNN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PER PROVIDER THE RIGHT SIDE LATERAL CRACKED OFF AND WILL NOT SUPPORT THE END USER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    231000 WHEELCHAIR COMPONENTS 890.3920 KNN MOTION CONCEPTS MPBD

    Patients

    Seq Age Sex Outcome Treatment
    1 Other