FDA Adverse Event
Malfunction
Summary report: N
WHEELCHAIR COMPONENTS
MDR report key: 3183103
·
Received June 21, 2013
Report
- Report Number
- 9615350-2013-00013
- Event Type
- Malfunction
- Date Received
- June 21, 2013
- Report Date
- May 28, 2013
- Manufacturer
- MOTION CONCEPTS
- Product Code
- KNN
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- UT, US
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Description of Event or Problem · 1
PROVIDER STATES HARDWARE BROKE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 283553 | WHEELCHAIR COMPONENTS | 890.3920 | KNN | MOTION CONCEPTS | PBE1612 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |