MAUDE Adverse Event Report: C.T.M. SHANGHAI MICROPORTABLE 3 WHEEL (RED) 9153645577; VEHICLE, MOTORIZED 3-WHEELED

Model Number L-3R

Device Problem Break (1069)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Type  malfunction  

Event Description

The consumer states that the scooter keeps stopping and sometimes won't start again.

• Brand Name: MICROPORTABLE 3 WHEEL (RED) 9153645577
• Type of Device: VEHICLE, MOTORIZED 3-WHEELED
• Manufacturer (Section D): C.T.M. SHANGHAI; 1158 yuan qu road; anting town; shanghai 2018 05; CH 201805
• MDR Report Key: 4348556
• MDR Text Key: 5216631
• Report Number: 1531186-2014-06616
• Device Sequence Number: 1
• Product Code: INI
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Distributor
• Source Type: Invalid Data
• Reporter Occupation: Patient
• Type of Report: Initial
• Report Date: 12/19/2014,12/02/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: L-3R
• 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: 12/19/2014
• Distributor Facility Aware Date: 12/02/2014
• Date Report to Manufacturer: 12/19/2014
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 12/19/2014
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other