BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TRACER TRANSPORT CHAIR 17 X 16 9153647024

    MDR report key: 4959901 · Received August 3, 2015

    Report

    Report Number
    9616091-2015-01982
    Event Type
    Malfunction
    Date Received
    August 3, 2015
    Date of Event
    December 1, 2014
    Report Date
    July 9, 2015
    Manufacturer
    INVAMEX
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL RECORD WILL BE FILED.

    Description of Event or Problem · 1

    DEALER STATES ON (B)(6) 2014 END USER STATED THE LEFT WHEEL LOCK WAS NOT HOLDING. DEALER STATED IT WAS BENT AND REPLACED THE LEFT WHEEL LOCK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    505225 TRACER TRANSPORT CHAIR 17 X 16 9153647024 WHEELCHAIR, MECHANICAL IOR INVAMEX TRSX5

    Patients

    Seq Age Sex Outcome Treatment
    1 Other