BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 3963243 · Received July 29, 2014

    Report

    Report Number
    1525712-2014-04030
    Event Type
    Malfunction
    Date Received
    July 29, 2014
    Date of Event
    June 18, 2014
    Report Date
    June 19, 2014
    Manufacturer
    UNKNOWN
    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

    THE PROVIDER ALLEGES THE CAM HOUSING AND CAM LEVEL WERE MISSING FROM BOTH SIDES OF THE UPPER SUPPORT ON A T93HA FRONT RIGGINS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    440811 WHEELCHAIR COMPONENTS 890.3920 KNN UNKNOWN T93HA

    Patients

    Seq Age Sex Outcome Treatment
    1 Other