BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SITZ BATH 1616700692

    MDR report key: 5056816 · Received September 4, 2015

    Report

    Report Number
    1219590-2015-00138
    Event Type
    Malfunction
    Date Received
    September 4, 2015
    Report Date
    August 10, 2015
    Manufacturer
    INVACARE CLEVELAND STREET
    Product Code
    KTC
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

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

    Description of Event or Problem · 1

    TUB HAS A SEAL WHICH IS COMING OFF OF THE TUB DOOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    589619 SITZ BATH 1616700692 BATH, SITZ, NONPOWERED KTC INVACARE CLEVELAND STREET IH3652G

    Patients

    Seq Age Sex Outcome Treatment
    1 Other