MAUDE Adverse Event Report: POPULAR PLASTICS WHEELCHAIR COMPONENTS; 890.3920

Model Number T94HE_37919

Device Problem Difficult to Fold, Unfold or Collapse (1254)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Type  No Answer Provided  

Event Description

It was reported that the riggings are jammed and will not adjust on the unknown manual wheelchair.

• Brand Name: WHEELCHAIR COMPONENTS
• Type of Device: 890.3920
• Manufacturer (Section D): POPULAR PLASTICS; guangzhou & donggua ; CH
• MDR Report Key: 3767196
• MDR Text Key: 4465156
• Report Number: 1531186-2014-01484
• Device Sequence Number: 1
• Product Code: KNN
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Invalid Data
• Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date: 04/23/2014,03/21/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/23/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: T94HE_37919
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: Yes
• Date Report Sent to FDA: 04/23/2014
• Distributor Facility Aware Date: 03/21/2014
• Device Age: 6 MO
• Date Report to Manufacturer: 04/23/2014
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other