BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3130206 · Received May 24, 2013

    Report

    Report Number
    1525712-2013-04163
    Event Type
    Malfunction
    Date Received
    May 24, 2013
    Report Date
    May 1, 2013
    Manufacturer
    UNKNOWN
    Product Code
    INM
    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 A PIECE OF THE FRONT RIGGINGS ON AN UNKNOWN MANUAL WHEELCHAIR BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    230989 WHEELCHAIR COMPONENTS 890.3920 INM UNKNOWN T93HE

    Patients

    Seq Age Sex Outcome Treatment
    1 Other