BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TRANSPORT 20 IN X 16 IN 9153637574

    MDR report key: 4973551 · Received August 5, 2015

    Report

    Report Number
    1525712-2015-04169
    Event Type
    Malfunction
    Date Received
    August 5, 2015
    Report Date
    July 14, 2015
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    PATIENT

    Narratives

    Additional Manufacturer Narrative · 1

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

    Description of Event or Problem · 1

    THE CONSUMER STATES THE BACK BRACKET ON THE BACK CANES HAS BROKEN. WE NO LONGER HAVE PARTS FOR THIS CHAIR, SO ARE UNABLE TO REPLACE THE PART. NO FURTHER INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    517360 TRANSPORT 20 IN X 16 IN 9153637574 WHEELCHAIR, MECHANICAL IOR INVACARE TAYLOR STREET AX3

    Patients

    Seq Age Sex Outcome Treatment
    1 Other