MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-06-27 for INVACARE MATRX PERSONAL BACK10 TALL 16 WIDE 9153652439 PBT16 manufactured by Invacare Cleveland Street.
[48578860]
The underlying cause could not be determined however the issue was confirmed for a cracked seat shell. Mdr is being submitted as a result of a retrospective complaint review.
Patient Sequence No: 1, Text Type: N, H10
[48578861]
The back is cracked and the hardware is broken as well.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1219590-2016-00114 |
| MDR Report Key | 5752016 |
| Date Received | 2016-06-27 |
| Date of Report | 2012-05-04 |
| Date Mfgr Received | 2012-05-04 |
| Date Added to Maude | 2016-06-27 |
| 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 | 3 |
| Event Location | 3 |
| Manufacturer Contact | KEVIN GUYTON |
| Manufacturer Street | ONE INVACARE WAY |
| Manufacturer City | ELYRIA OH 44035 |
| Manufacturer Country | US |
| Manufacturer Postal | 44035 |
| Manufacturer Phone | 8003336900 |
| Manufacturer G1 | INVACARE CLEVELAND STREET |
| Manufacturer Street | 899 CLEVELAND STREET |
| Manufacturer City | ELYRIA OH 44036 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 44036 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | INVACARE MATRX PERSONAL BACK10 TALL 16 WIDE 9153652439 |
| Generic Name | CUSHION, WHEELCHAIR |
| Product Code | IMP |
| Date Received | 2016-06-27 |
| Returned To Mfg | 2012-06-06 |
| Model Number | PBT16 |
| Operator | LAY USER/PATIENT |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | INVACARE CLEVELAND STREET |
| Manufacturer Address | 899 CLEVELAND STREET ELYRIA OH 44036 US 44036 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2016-06-27 |