BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2914672 · Received January 14, 2013

    Report

    Report Number
    1525712-2013-00367
    Event Type
    Malfunction
    Date Received
    January 14, 2013
    Report Date
    January 14, 2013
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(6) -THE DEALER REPORTED THAT THE UNKNOWN MODEL AND SERIAL NUMBERS POWER WHEELCHAIR JOYSTICK HAD AN INTERMITTENT CABLE CONNECTION. THERE WAS NO PATIENT INJURY REPORTED.-

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    20500 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other