BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T4/WD2418/HD/ADULT/18/BH16/AT903/U2222C/COM/U550 9153639568

    MDR report key: 4811624 · Received June 2, 2015

    Report

    Report Number
    9616091-2015-01387
    Event Type
    Malfunction
    Date Received
    June 2, 2015
    Report Date
    May 4, 2015
    Manufacturer
    INVAMEX
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    SHOULD MORE PERTINENT INFORMATION BECOME AVAILABLE A SUPPLEMENTAL REPORT WILL BE FILED

    Description of Event or Problem · 1

    THE DEALER STATES ONE REAR WHEEL HAD BROKEN SPOKES RIGHT OUT OF THE BOX.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    356885 T4/WD2418/HD/ADULT/18/BH16/AT903/U2222C/COM/U550 9153639568 WHEELCHAIR, MECHANICAL IOR INVAMEX T422RDAP

    Patients

    Seq Age Sex Outcome Treatment
    1 Other