MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2015-02-02 for CLINICAL RECLINER BLUE RIDGE 9153641321 IH6077A/IH61 manufactured by Invacare Rehabilitation Equip.
[5570433]
It was reported that the frame is broke by the recline mechanism on the (b)(4) irecliner.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3008262382-2015-00399 |
| MDR Report Key | 4472691 |
| Report Source | 08 |
| Date Received | 2015-02-02 |
| Date of Report | 2015-01-23 |
| Date Mfgr Received | 2015-01-23 |
| Date Added to Maude | 2015-03-06 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| 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 | 0 |
| Event Location | 0 |
| Manufacturer Contact | KEVIN GUYTON |
| Manufacturer Street | ONE INVACARE WAY |
| Manufacturer City | ELYRIA OH 44036 |
| Manufacturer Country | US |
| Manufacturer Postal | 44036 |
| Manufacturer Phone | 8003336900 |
| Manufacturer G1 | INVACARE REHABILITATION EQUIP |
| Manufacturer Street | NO.435 XIEYU STREET SUZHOU INDUSTRIAL PARK |
| Manufacturer City | JIANGSU, P.RC. 215026 |
| Manufacturer Country | CH |
| Manufacturer Postal Code | 215026 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CLINICAL RECLINER BLUE RIDGE 9153641321 |
| Generic Name | CHAIR AND TABLE, MEDICAL |
| Product Code | KMN |
| Date Received | 2015-02-02 |
| Model Number | IH6077A/IH61 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | INVACARE REHABILITATION EQUIP |
| Manufacturer Address | NO.435 XIEYU STREET SUZHOU INDUSTRIAL PARK JIANGSU, P.RC. 215026 CH 215026 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2015-02-02 |