BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3736775 · Received April 9, 2014

    Report

    Report Number
    1525712-2014-01755
    Event Type
    Malfunction
    Date Received
    April 9, 2014
    Report Date
    March 11, 2014
    Manufacturer
    UNKNOWN
    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

    IT WAS REPORTED THE LEG REST HAS BROKEN AT THE FOOT PLATE AND HINGE. NO PATIENT CONSEQUENCES WERE REPORTED AS A RESULT OF THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    215511 WHEELCHAIR COMPONENTS 890.3920 KNN UNKNOWN T94HC

    Patients

    Seq Age Sex Outcome Treatment
    1 Other