BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2874775 · Received December 16, 2012

    Report

    Report Number
    1525712-2012-03053
    Event Type
    Malfunction
    Date Received
    December 16, 2012
    Report Date
    December 15, 2012
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AZ, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) - NO RMA HAS BEEN INITIATED FOR THIS ISSUE. THE MALFUNCTION HAS NOT BEEN CONFIRMED.

    Description of Event or Problem · 1

    DEALER STATES THE PISTON HAD OIL VAPOR COMING OFF OF IT. AFTER HE ADJUSTED THE PISTON AND PUT HIS FEET BEHIND THE REAR CASTERS, PULLED BACK ON THE BACK CANES TO LIFT UP THE FRONT, ONE OF THE CASTERS DROPPED AND ONE STAYED LIFTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 8 Other