FDA Adverse Event
Malfunction
Summary report: N
POWERED WHEELCHAIR
MDR report key: 2880319
·
Received December 19, 2012
Report
- Report Number
- 1525712-2012-03135
- Event Type
- Malfunction
- Date Received
- December 19, 2012
- Report Date
- December 18, 2012
- Manufacturer
- INVACARE TAYLOR STREET
- Product Code
- ITI
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IL, US
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Description of Event or Problem · 1
PROVIDER STATES TILT NOT WORKING RIGHT AND CUSTOMER WAS STUCK ON THE SIDEWALK. THE REPORTER HAS BEEN CONTACTED FOR ADDITIONAL INFORMATION HOWEVER TO DATE NO UPDATE HAS BEEN RECEIVED. PLEASE NOTE ANY FURTHER INFORMATION WILL BE PROVIDED IN A SUPPLEMENTAL REPORT. IT WAS REPORTED NO INJURY. THE POWERED WHEELCHAIR HAS BEEN USED FOR OVER 5 YEARS AND IS A DISCONTINUED PRODUCT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | POWERED WHEELCHAIR | 890.3860 | ITI | INVACARE TAYLOR STREET | 2GRWDAR-T |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |