FDA.reportPublic FDA data

MAUDE MDR 3575022

MDR report key
3575022
Report number
1525712-2014-00229
Event key
0
Event type
3
Date received
2014-01-14
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
403
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
PATRICIA MEDINA
Address
ONE INVACARE WAY ELYRIA OH 44035 US
Phone
999-999-9999
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1WHEELCHAIR COMPONENTS890.3920UNKNOWNIMMT93HE_PTO_37918R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-01-1401. O

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT THE RIGGING FOOT REST IS CRACKED.