MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a * report with the FDA on 2015-01-08 for 3 POSITION RECLINER DELUXE-ADULT ROSEWOOD 9153641333 IH6065A manufactured by Goodbaby.
[18036867]
The provider states both of the rear locking wheels on this chair are broken as well as the locking positioning bar. No additional information available per facility rep 7857hf.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1531186-2015-00038 |
| MDR Report Key | 4395251 |
| Report Source | * |
| Date Received | 2015-01-08 |
| Date of Report | 2014-12-12 |
| Date Facility Aware | 2014-12-12 |
| Report Date | 2015-01-05 |
| Date Reported to FDA | 2015-01-05 |
| Date Reported to Mfgr | 2015-01-05 |
| Date Added to Maude | 2015-01-08 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Single Use | 0 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 3 POSITION RECLINER DELUXE-ADULT ROSEWOOD 9153641333 |
| Generic Name | CHAIR AND TABLE, MEDICAL |
| Product Code | KMN |
| Date Received | 2015-01-08 |
| Model Number | IH6065A |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | 22 MO |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | GOODBABY |
| Manufacturer Address | CH |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2015-01-08 |