BEUDAMED
    FDA Adverse Event Summary report: N

    MECHANICAL (MANUAL) WHEELCHAIR

    MDR report key: 4133076 · Received October 1, 2014

    Report

    Report Number
    1531186-2014-04630
    Date Received
    October 1, 2014
    Date of Event
    September 12, 2014
    Report Date
    September 15, 2014
    Manufacturer
    JUMAO - JM - E. CHINA
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATED THE END USER WAS GOING DOWN THE HALLWAY AND RUBBER CAME OFF THE TIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    611520 MECHANICAL (MANUAL) WHEELCHAIR 890.3850 IOR JUMAO - JM - E. CHINA V20RFR

    Patients

    Seq Age Sex Outcome Treatment
    1 64 MO Other