BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2843928 · Received November 23, 2012

    Report

    Report Number
    9616091-2012-00546
    Event Type
    Malfunction
    Date Received
    November 23, 2012
    Report Date
    November 23, 2012
    Manufacturer
    INVAMEX
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) NO RMA HAS BEEN INITIATED FOR THIS ISSUE. MODEL 9XDT , SERIAL NUMBER/DATE (B)(4) IS APPROXIMATELY 1 MONTH OLD. THE OWNER'S MANUAL PART NUMBER 1118386 REV D(APR-07), WAS ISSUED WITH THIS DEVICE. THE OWNER'S MANUAL IS ALSO FOUND ON-LINE AT INVACARE.COM. IT IS UNKNOWN IF THE CONSUMER HAS FULLY READ AND UNDERSTANDS THE OWNER'S MANUAL. DOCUMENTATION PROVIDES WARNINGS, CAUTIONS, AND INSTRUCTIONS FOR SAFELY USING THE DEVICE. IF THE CONSUMER DOES NOT UNDERSTAND THE WRITTEN WARNINGS, CAUTIONS OR INSTRUCTIONS THEN THEY SHOULD CONTACT INVACARE. THE CONSUMER'S AGE, HEIGHT AND WEIGHT ARE UNKNOWN. THE CONSUMER'S MEDICAL CONDITION, STABILITY AND MEDICATION REGIMEN ARE UNKNOWN. THE CONSUMER'S TECHNIQUE WHILE USING THE DEVICE IS UNKNOWN. THE MAINTENANCE HISTORY OF THE DEVICE IS UNKNOWN. THE MALFUNCTION HAS NOT BEEN CONFIRMED. POTIENTIAL FOR THE CHAIR TO BECOME UNSTABLE, CLIENT STATES THAT THE WHEEL IS RUBBING AND SAYS IT IS ALMOST LIKE THE WHEEL IS OUT OF ROUND (WARPED).

    Description of Event or Problem · 1

    CLIENT STATES THAT THE WHEEL IS RUBBING AND SAYS IT IS ALMOST LIKE THE WHEEL IS OUT OF ROUND (WARPED). IT HAS BEEN REPAIRED AND END USER IS ABLE TO USE AGAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POWERED WHEELCHAIR 890.3860 ITI INVAMEX 9XDT

    Patients

    Seq Age Sex Outcome Treatment
    1 Other