BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2884512 · Received December 22, 2012

    Report

    Report Number
    1525712-2012-03234
    Event Type
    Malfunction
    Date Received
    December 22, 2012
    Date of Event
    November 24, 2012
    Report Date
    December 21, 2012
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(6) -2012 - THE DEALER REPORTED THAT THE UNKNOWN MODEL AND SERIAL NUMBERS POWER WHEELCHAIR WAS UNABLE TO REVERSE, AND THE JOYSTICK HAS FELL OFF. THERE WAS NO PATIENT INJURY REPORTED.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 37 Other