BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TREX2/WD06/18/BH16/U2222C/ADULT/U67/1255 9153653553

    MDR report key: 4356801 · Received December 23, 2014

    Report

    Report Number
    1525712-2014-08874
    Event Type
    Malfunction
    Date Received
    December 23, 2014
    Report Date
    December 3, 2014
    Manufacturer
    UNKNOWN
    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

    THE CALLER STATES THAT THE LEFT REAR SEAT GUIDE ON THE CHAIR IS BROKEN. THE CALLER WAS UNABLE TO READ THE SERIAL NUMBER ON THE CHAIR BECAUSE IT WAS RUBBED OFF. WE DETERMINED THAT THE CHAIR WAS A TRACER EX. I GAVE HIM A PART NUMBER FOR THE SEAT GUIDE (#1023617). HE WILL GIVE IT TO HIS MAINTENANCE MAN WHO WILL ORDER THE PART.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    847731 TREX2/WD06/18/BH16/U2222C/ADULT/U67/1255 9153653553 WHEELCHAIR, MECHANICAL IOR UNKNOWN TREX

    Patients

    Seq Age Sex Outcome Treatment
    1 Other