BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3233139 · Received July 18, 2013

    Report

    Report Number
    9615350-2013-00015
    Event Type
    Malfunction
    Date Received
    July 18, 2013
    Report Date
    June 26, 2013
    Manufacturer
    MOTION CONCEPTS
    Product Code
    KNN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER ADVISED BACK SHELL IS BENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    333555 WHEELCHAIR COMPONENTS 890.3920 KNN MOTION CONCEPTS EDB1616

    Patients

    Seq Age Sex Outcome Treatment
    1 Other