INVACARE MATRX PB DEEP 16X20 9153652328 PBD1620

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2014-12-18 for INVACARE MATRX PB DEEP 16X20 9153652328 PBD1620 manufactured by Unknown.

Event Text Entries

[17291202] The dealer stated the back is stripped where the bolt goes into to secure to chair. He found issue prior to placing on patient no injuries.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1525712-2014-08738
MDR Report Key4341420
Report Source08
Date Received2014-12-18
Date of Report2014-11-25
Date Mfgr Received2014-11-25
Date Added to Maude2015-01-05
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationMEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactKEVIN GUYTON
Manufacturer StreetONE INVACARE WAY
Manufacturer CityELYRIA OH 44036
Manufacturer CountryUS
Manufacturer Postal44036
Manufacturer Phone8003336900
Manufacturer G1UNKNOWN
Manufacturer CityOH
Manufacturer CountryUS
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameINVACARE MATRX PB DEEP 16X20 9153652328
Generic NameCUSHION, WHEELCHAIR
Product CodeIMP
Date Received2014-12-18
Model NumberPBD1620
OperatorLAY USER/PATIENT
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerUNKNOWN
Manufacturer AddressOH US


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2014-12-18

© 2024 FDA.report
This site is not affiliated with or endorsed by the FDA.