BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T4/WD08/HD/ADULT/28/BH16/AT903/U2222C/COM/U550 9153639974

    MDR report key: 5123816 · Received October 2, 2015

    Report

    Report Number
    9616091-2015-02409
    Event Type
    Malfunction
    Date Received
    October 2, 2015
    Report Date
    September 4, 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

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

    Description of Event or Problem · 1

    DEALER STATES THE RIGHT SIDE WHEEL LOCK IS BENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    653869 T4/WD08/HD/ADULT/28/BH16/AT903/U2222C/COM/U550 9153639974 WHEELCHAIR, MECHANICAL IOR INVAMEX T420RDA

    Patients

    Seq Age Sex Outcome Treatment
    1