BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2893867 · Received January 2, 2013

    Report

    Report Number
    1525712-2013-00043
    Event Type
    Malfunction
    Date Received
    January 2, 2013
    Report Date
    January 2, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATED THE RECLINE MECHANISM IS BROKEN. NO INJURY. THE POWERED WHEELCHAIR HAS BEEN IN USE OVER 5 YEARS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    929 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GTQ-MCG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other