FDA Adverse Event
Malfunction
Summary report: N
TRACER TRANSPORT CHAIR 19 X 16 9153647029
MDR report key: 4928823
·
Received July 21, 2015
Report
- Report Number
- 9616091-2015-01869
- Event Type
- Malfunction
- Date Received
- July 21, 2015
- Report Date
- June 25, 2015
- Manufacturer
- INVAMEX
- Product Code
- IOR
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- LA, US
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Additional Manufacturer Narrative · 1
FOLLOW UP TO BE SENT IF ADDITIONAL INFORMATION IS RECEIVED.
Description of Event or Problem · 1
DEALER ADVISED BACK LEFT SIDE FRAME IS BROKEN AT A WELD. DEALER COULD NOT PROVIDE ANY FURTHER INFORMATION.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 473211 | TRACER TRANSPORT CHAIR 19 X 16 9153647029 | WHEELCHAIR, MECHANICAL | IOR | INVAMEX | T4X22RDA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |