BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HTR5500 HTR-DELUXE MODEL 5500 9153635378

    MDR report key: 4370318 · Received December 30, 2014

    Report

    Report Number
    1525712-2014-09012
    Event Type
    Malfunction
    Date Received
    December 30, 2014
    Report Date
    December 9, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    FRK
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PART ON LEG IS BROKEN. EXCHANGED HTR CHAIR SKU 0131769 FOR SKU 013189 SERIAL NUMBER (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    860109 HTR5500 HTR-DELUXE MODEL 5500 9153635378 CHAIR AND TABLE, MEDICAL FRK INVACARE TAYLOR STREET HTR5500

    Patients

    Seq Age Sex Outcome Treatment
    1 Other