BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3230655 · Received July 16, 2013

    Report

    Report Number
    9616091-2013-01233
    Event Type
    Malfunction
    Date Received
    July 16, 2013
    Report Date
    June 26, 2013
    Manufacturer
    INVAMEX
    Product Code
    KNN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE PROVIDER STATED THE LEVER AND THE FOOTPLATES HAVE BROKEN ON THE LEGRESTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    330087 WHEELCHAIR COMPONENTS 890.3920 KNN INVAMEX T94HC

    Patients

    Seq Age Sex Outcome Treatment
    1 Other