BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2914543 · Received January 14, 2013

    Report

    Report Number
    1525712-2013-00357
    Event Type
    Malfunction
    Date Received
    January 14, 2013
    Date of Event
    December 17, 2012
    Report Date
    January 14, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    A DEALER REPORTED THAT A LEFT MOTOR IS WIRED WRONG. THE PROGRAMMING SHOWS A M91 CHAIR AND THIS DEVICE IS A UNSPECIFIED TDX POWERED WHEELCHAIR AND WAS NOTED PERFORMING OPPOSITE COMMANDS. A SUPPLEMENTAL REPORT WILL BE FILED IF ANY FURTHER INFORMATION IS RECEIVED. NO INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    20829 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDX

    Patients

    Seq Age Sex Outcome Treatment
    1 Other