Brand Name | SCOOTER MIDSIZE 3 WHEEL BLUE 9153652394 |
Type of Device | VEHICLE, MOTORIZED 3-WHEELED |
Manufacturer (Section D) |
INVACARE TAYLOR STREET |
1200 taylor street |
elyria OH 44036 |
|
Manufacturer (Section G) |
INVACARE TAYLOR STREET |
1200 taylor street |
|
elyria OH 44036 |
|
Manufacturer Contact |
kevin
guyton
|
one invacare way |
elyria, OH 44035
|
8003336900
|
|
MDR Report Key | 5139858 |
MDR Text Key | 28215155 |
Report Number | 1525712-2015-04812 |
Device Sequence Number | 1 |
Product Code |
INI
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor |
Reporter Occupation |
Medical Equipment Company Technician/Representative
|
Report Date |
09/15/2015 |
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 | HMV4B18 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
Not provided |
Initial Date FDA Received | 10/09/2015 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |