BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3953064 · Received July 23, 2014

    Report

    Report Number
    1525712-2014-03998
    Event Type
    Malfunction
    Date Received
    July 23, 2014
    Date of Event
    June 16, 2014
    Report Date
    June 16, 2014
    Manufacturer
    UNKNOWN
    Product Code
    KNN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATES THE COMPOSITE FOOTPLATES ON THE FOOTREST ARE BROKEN WHERE IT ATTACHES TO THE PIVOT TUBE

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    430093 WHEELCHAIR COMPONENTS 890.3920 KNN UNKNOWN T94HE

    Patients

    Seq Age Sex Outcome Treatment
    1 Other