BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ADJUSTABLE BASE ONLY 9153618937

    MDR report key: 4823405 · Received June 8, 2015

    Report

    Report Number
    3008262382-2015-01320
    Event Type
    Malfunction
    Date Received
    June 8, 2015
    Report Date
    May 18, 2015
    Manufacturer
    INVACARE REHABILITATION EQUIPMENT CO.
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    A FOLLOW UP WILL BE SENT IF THE PRODUCT OR ADDITIONAL INFORMATION IS OBTAINED.

    Description of Event or Problem · 1

    (B)(4). THE PROVIDER STATES THE CASTER IS BROKEN ON THE BASE FROM ORDER NUMBER (B)(4). NO INJURIES NOTED. THE CALLER DIDN'T HAVE ADDITIONAL INFORMATION REGARDING THE ISSUE (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    367202 ADJUSTABLE BASE ONLY 9153618937 LIFT, PATIENT, NON-AC-POWERED FSA INVACARE REHABILITATION EQUIPMENT CO. 9884

    Patients

    Seq Age Sex Outcome Treatment
    1 Other