BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    P300 (20") POWER W/CHAIR

    MDR report key: 53738 · Received December 4, 1996

    Report

    Report Number
    2082643-1996-00588
    Event Type
    Malfunction
    Date Received
    December 4, 1996
    Date of Event
    November 13, 1996
    Report Date
    December 4, 1996
    Manufacturer
    QUICKIE DESIGNS, INC.
    Product Code
    ITI
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    9/10 X 3 FORK/STEM WHDWR P3. DEALER CLAIMS FORK STEM CRACKED IN HALF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 P300 (20") POWER W/CHAIR WHEELCHAIR-MECHANICAL ITI QUICKIE DESIGNS, INC. NA P/N-780921

    Patients

    Seq Age Sex Outcome Treatment
    1 14 YR Other