BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    P300 (20") POWER W/CHAIR

    MDR report key: 49701 · Received November 15, 1996

    Report

    Report Number
    2082643-1996-00438
    Event Type
    Malfunction
    Date Received
    November 15, 1996
    Date of Event
    October 16, 1996
    Report Date
    November 15, 1996
    Manufacturer
    QUICKIE DESIGNS INC.
    Product Code
    ITI
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    8 X 2 FORK/STEM ASSM PWR THICK. DEALER CLAIMS: END USER BRUSHED UP AGAINST THE CURB AND THE FORK STEM SHEARED RIGHT OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 P300 (20") POWER W/CHAIR WHEELCHAIR-POWERED ITI QUICKIE DESIGNS INC. NA P/N-787130

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Other