BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T4/WD28/HD/ADULT/18/BH16/AT903/U2222C/U67 9153653569

    MDR report key: 4886424 · Received July 2, 2015

    Report

    Report Number
    9616091-2015-01724
    Event Type
    Malfunction
    Date Received
    July 2, 2015
    Report Date
    June 5, 2015
    Manufacturer
    INVAMEX
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE A SUPPLEMENTAL RECORD WILL BE FILED.

    Description of Event or Problem · 1

    DEALER IS STATING THAT THE WHEEL LOCKS ARE BENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    432599 T4/WD28/HD/ADULT/18/BH16/AT903/U2222C/U67 9153653569 WHEELCHAIR, MECHANICAL IOR INVAMEX T4

    Patients

    Seq Age Sex Outcome Treatment
    1 Other