MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-10-09 for EXCEL BASIC ALUMINUM TRANSPORT MDS808210ARE manufactured by Medline Industries Inc..
[123488580]
Received new chair on morning of (b)(6) 2018. Unpacked it and checked for any defects, none were found. Had client sit in chair and test it in house, no problems. Went to (b)(6) that afternoon and within an hour of arrival, the right front wheel fork buckled.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | MW5080428 |
| MDR Report Key | 7951726 |
| Date Received | 2018-10-09 |
| Date of Report | 2018-10-05 |
| Date of Event | 2018-09-29 |
| Date Added to Maude | 2018-10-10 |
| Event Key | 0 |
| Report Source Code | Voluntary report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | EXCEL BASIC ALUMINUM TRANSPORT |
| Generic Name | CHAIR, WITH CASTERS |
| Product Code | INM |
| Date Received | 2018-10-09 |
| Model Number | MDS808210ARE |
| Lot Number | 15118060001 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | I |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDLINE INDUSTRIES INC. |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-10-09 |