Brand Name | 3 POSITION RECLINER-BASIC BLUE RIDGE 9153641336 |
Type of Device | CHAIR AND TABLE, MEDICAL |
Manufacturer (Section D) |
|
MDR Report Key | 4383294 |
MDR Text Key | 5288126 |
Report Number | 1531186-2014-07098 |
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 |
12/31/2014,12/10/2014 |
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 | IH6074A/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 | 12/31/2014 |
Distributor Facility Aware Date | 12/10/2014 |
Date Report to Manufacturer | 12/31/2014 |
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 01/06/2015 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
|
|