BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2912109 · Received January 11, 2013

    Report

    Report Number
    1525712-2013-00281
    Event Type
    Malfunction
    Date Received
    January 11, 2013
    Date of Event
    December 13, 2012
    Report Date
    January 11, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATES CHAIR WILL RANDOMLY DRIVE INHIBIT WHEN NOT TILTED. NO INJURY. PLEASE NOTE ANY FURTHER INFORMATION RECEIVED WILL BE REPORTED IN A SUPPLEMENTAL REPORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    17067 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSPREE-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other