BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TRANSPORT 20 IN X 16 IN 9153637574

    MDR report key: 4956288 · Received July 31, 2015

    Report

    Report Number
    1525712-2015-04091
    Event Type
    Malfunction
    Date Received
    July 31, 2015
    Report Date
    July 8, 2015
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, 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 STATES THE RIGHT SIDE CROSSBRACE BROKE AT A WELD. DEALER STATES WHEN THE CROSSBRACE BROKE, IT RUINED THE SEAT UPHOLSTERY AND NOW THE SEAT UPHOLSTERY NEEDS REPLACED. NO INJURY REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    500018 TRANSPORT 20 IN X 16 IN 9153637574 WHEELCHAIR, MECHANICAL IOR INVACARE TAYLOR STREET XTRA

    Patients

    Seq Age Sex Outcome Treatment
    1 Other