BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DEMO 1 REVEAL WHEELCHAIR SHOW CHAIR

    MDR report key: 5123993 · Received October 2, 2015

    Report

    Report Number
    1525712-2015-04728
    Event Type
    Malfunction
    Date Received
    October 2, 2015
    Report Date
    September 8, 2015
    Manufacturer
    INVACARE TAYLOR STREET
    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, A SUPPLEMENTAL RECORD WILL BE FILED.

    Description of Event or Problem · 1

    THE DEALER STATES WHEN THEY TOOK THE CHAIR OUT OF THE TRUNK OF THE CAR, THE CASTER CAME OFF. THE DEALER STATES IT IS THE CASTER HOLDER THAT BROKE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    655222 DEMO 1 REVEAL WHEELCHAIR SHOW CHAIR WHEELCHAIR, MECHANICAL IOR INVACARE TAYLOR STREET RVL

    Patients

    Seq Age Sex Outcome Treatment
    1