BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUICKIE 3RX

    MDR report key: 78702 · Received March 25, 1997

    Report

    Report Number
    2082643-1997-00420
    Event Type
    Malfunction
    Date Received
    March 25, 1997
    Date of Event
    March 12, 1997
    Report Date
    March 25, 1997
    Manufacturer
    QUICKIE DESIGNS, INC.
    Product Code
    IOR
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    X-TUBE ASSM 18" X 16". DEALER CLAIMS X-TUBE BROKE AT THE BOLT HOLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKIE 3RX WHEELCHAIR, MECHANICAL IOR QUICKIE DESIGNS, INC. NA P/N-672816

    Patients

    Seq Age Sex Outcome Treatment
    1 25 YR Other