BEUDAMED
    FDA Adverse Event Summary report: N

    WHEELCHAIR COMPONENTS

    MDR report key: 4223040 · Received November 4, 2014

    Report

    Report Number
    1531186-2014-05339
    Date Received
    November 4, 2014
    Report Date
    October 15, 2014
    Manufacturer
    UNKNOWN
    Product Code
    IOR
    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

    THE DEALER STATED BOTH FOOTPLATE WERE CRACKED BY THE END USER. THE DEALER STATED HE DID NOT BELIEVE THIS WAS A MANUFACTURING DEFECT. THE DEALER DID NOT PROVIDE THE SERIAL NUMBER, SO WE ARE UNABLE TO VERIFY THE CHAIR MODEL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    707951 WHEELCHAIR COMPONENTS 890.3920 IOR UNKNOWN T94HC

    Patients

    Seq Age Sex Outcome Treatment
    1 Other