BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2874804 · Received December 16, 2012

    Report

    Report Number
    1525712-2012-03079
    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
    NY, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATED THAT USER WAS DRIVING THE TDXSR-CG-HD POWER CHAIR DOWN THE SIDEWALK AND ALLEGEDLY RAN INTO A SNOW BANK, SNAPPING OFF THE FOOTBOARD AND BENDING THE ACTUATOR MOTOR.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 60 Other