BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MECHANICAL (MANUAL) WHEELCHAIR

    MDR report key: 4143365 · Received October 6, 2014

    Report

    Report Number
    9616091-2014-02096
    Event Type
    Malfunction
    Date Received
    October 6, 2014
    Date of Event
    September 12, 2014
    Report Date
    September 18, 2014
    Manufacturer
    INVACARE REHABILITATION EQUIP
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATED THAT THE FORK ON A (B)(4) WHEELCHAIR SPLIT, WHERE THE WELDED STEM IS. THE END USER WAS BEING PUSHED DOWN THE STREET AND THE FORK COLLAPSED, NO INJURIES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    622619 MECHANICAL (MANUAL) WHEELCHAIR 890.3850 IOR INVACARE REHABILITATION EQUIP SOLARA3G

    Patients

    Seq Age Sex Outcome Treatment
    1 Other