BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2893603 · Received January 2, 2013

    Report

    Report Number
    1525712-2013-00011
    Event Type
    Malfunction
    Date Received
    January 2, 2013
    Date of Event
    November 30, 2012
    Report Date
    January 1, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    A REPORT FROM A (B)(6) PROVIDER STATES THE AXLE BROKE OFF THE GEARBOX. NO INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    711 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GAR

    Patients

    Seq Age Sex Outcome Treatment
    1 Other