MAUDE Adverse Event Report: JUMAO HEALTHCARE EQUIPMENT TRSX5/WD86/ADULT/28FB/BH16/1255/U2222C/U240 9153653564; WHEELCHAIR, MECHANICAL

Model Number TRSX58FBP

Device Problem Product Quality Problem (1506)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Type  malfunction  

Event Description

Dealer alleges the right front caster on this brand new trsx58fbp wheelchair is up in the air causing the frame to be tweaked, no damage to box.

• Brand Name: TRSX5/WD86/ADULT/28FB/BH16/1255/U2222C/U240 9153653564
• Type of Device: WHEELCHAIR, MECHANICAL
• Manufacturer (Section D): JUMAO HEALTHCARE EQUIPMENT; jiashan ; CH
• MDR Report Key: 4510286
• MDR Text Key: 5530992
• Report Number: 1531186-2015-00942
• Device Sequence Number: 1
• Product Code: IOR
• 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: 02/11/2015,02/05/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/12/2015
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: TRSX58FBP
• 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: 02/11/2015
• Distributor Facility Aware Date: 02/05/2015
• Date Report to Manufacturer: 02/11/2015
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other