BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2930929 · Received January 28, 2013

    Report

    Report Number
    1525712-2013-00651
    Event Type
    Malfunction
    Date Received
    January 28, 2013
    Report Date
    January 26, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(4). NO SERIOUS INJURY ALLEGED. MALFUNCTION ALLEGED. PROVIDER STATES NO VOLTAGE TO PINS ONE AND TWO IN THE JOYSTICK. MDR FILED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    37607 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDX3

    Patients

    Seq Age Sex Outcome Treatment
    1 Other