BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2930625 · Received January 28, 2013

    Report

    Report Number
    1525712-2013-00613
    Event Type
    Malfunction
    Date Received
    January 28, 2013
    Report Date
    January 25, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DE, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATES RIGHT BRAKE FAULT. NO INJURY. POSSIBLY BOTH MOTORS WILL BE REPLACED. THE POWERED WHEELCHAIR IS APPROXIMATELY 9 YEARS OF AGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    37093 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M71

    Patients

    Seq Age Sex Outcome Treatment
    1 Other