MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor report with the FDA on 2016-06-28 for 3 POSITION RECLINER DELUXE-X WIDE ROSEWOOD 9153641330 9RC manufactured by Invamex.
[48344672]
Mdr is being submitted as a result of a retrospective complaint review. Recline slipping.
Patient Sequence No: 1, Text Type: N, H10
[48344673]
Recliner back assembly is slipping out of place.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9616091-2016-01040 |
| MDR Report Key | 5755388 |
| Report Source | DISTRIBUTOR |
| Date Received | 2016-06-28 |
| Date of Report | 2012-03-09 |
| Date Mfgr Received | 2012-03-09 |
| Date Added to Maude | 2016-06-28 |
| 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 | INVAMEX |
| Manufacturer Street | PARQUE INDUSTRIAL MANIMEX |
| Manufacturer City | REYNOSA 88780 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 88780 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 3 POSITION RECLINER DELUXE-X WIDE ROSEWOOD 9153641330 |
| Generic Name | CHAIR AND TABLE, MEDICAL |
| Product Code | KMN |
| Date Received | 2016-06-28 |
| Returned To Mfg | 2012-04-23 |
| Model Number | 9RC |
| Operator | LAY USER/PATIENT |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | INVAMEX |
| Manufacturer Address | PARQUE INDUSTRIAL MANIMEX REYNOSA 88780 MX 88780 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2016-06-28 |