MAUDE Adverse Event Report: GOODBABY 3 POSITION RECLINER-DELUXE ADULT BLUE RIDGE 9153641331; CHAIR AND TABLE, MEDICAL

Model Number IH6065A/IH61

Device Problem Unstable (1667)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 02/02/2015

Event Type  malfunction  

Event Description

Provider alleges the facility broke the lock mechanism on the casters (b)(4) recliner.

• Brand Name: 3 POSITION RECLINER-DELUXE ADULT BLUE RIDGE 9153641331
• Type of Device: CHAIR AND TABLE, MEDICAL
• Manufacturer (Section D): GOODBABY; CH
• MDR Report Key: 4501571
• MDR Text Key: 5440722
• Report Number: 1531186-2015-00881
• Device Sequence Number: 1
• Product Code: KMN
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Distributor
• Source Type: Invalid Data
• Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date: 02/09/2015,02/03/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/10/2015
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: IH6065A/IH61
• 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: 02/09/2015
• Distributor Facility Aware Date: 02/03/2015
• Date Report to Manufacturer: 02/09/2015
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other