BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3955443 · Received July 24, 2014

    Report

    Report Number
    1525712-2014-03977
    Event Type
    Malfunction
    Date Received
    July 24, 2014
    Report Date
    June 18, 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

    CUSTOMER ALLEGES THE T94HA_37804 FRONT RIGGINGS HAVE BROKEN PINS AND THE PLASTIC LEVER WHERE THE RIGGINGS ATTACH TO THE CHAIR HAS ALSO BROKEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    433702 WHEELCHAIR COMPONENTS 890.3920 KNN UNKNOWN T94HA_37804

    Patients

    Seq Age Sex Outcome Treatment
    1 Other