BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T4/WD28/HD/ADULT/18/BH16/AT903/U2222C/U67 9153653569

    MDR report key: 5004335 · Received August 14, 2015

    Report

    Report Number
    9616091-2015-02065
    Event Type
    Malfunction
    Date Received
    August 14, 2015
    Report Date
    July 22, 2015
    Manufacturer
    INVAMEX
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, 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

    END USER STATES, THE RIGHT FRAME IS BENT .

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    537851 T4/WD28/HD/ADULT/18/BH16/AT903/U2222C/U67 9153653569 WHEELCHAIR, MECHANICAL IOR INVAMEX T422RDA

    Patients

    Seq Age Sex Outcome Treatment
    1 Other