BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2880614 · Received December 19, 2012

    Report

    Report Number
    1525712-2012-03155
    Event Type
    Malfunction
    Date Received
    December 19, 2012
    Date of Event
    November 18, 2012
    Report Date
    December 19, 2012
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATES STUCK IN DRIVE LOCKOUT. A CALL WAS PLACED FOR ADDITIONAL INFORMATION. IT WAS LEARNED IN SPEAKING WITH THE REPORTER THAT THE END USER HAD REPORTED TO HIM THAT HE WAS GETTING PERIODICALLY LOCKED OUT. THE CHAIR HAS SINCE BEEN FIXED AND IS IN POSSESSION OF THE END-USER. NO INJURY.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 Other