BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HVY DUTY TRANSPORT 22 IN-W/FTRST 9153643753

    MDR report key: 4366541 · Received December 29, 2014

    Report

    Report Number
    1531186-2014-06928
    Event Type
    Malfunction
    Date Received
    December 29, 2014
    Report Date
    December 5, 2014
    Manufacturer
    KENSTONE METAL
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    OH, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER STATES, THE SHIMS THAT THE OTHER TUBE SLIDES IN AND OUT OF, THEY BREAK AND THEY ARE NOT A REPLACEMENT PART. HE HAS MULTIPLE CHAIRS HE IS WORKING ON BUT ONLY PROVIDED 1 SERIAL NUMBER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    853446 HVY DUTY TRANSPORT 22 IN-W/FTRST 9153643753 WHEELCHAIR, MECHANICAL IOR KENSTONE METAL TRHD22FR

    Patients

    Seq Age Sex Outcome Treatment
    1 Other