BEUDAMED
    FDA Adverse Event Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2940339 · Received February 2, 2013

    Report

    Report Number
    1525712-2013-00798
    Date Received
    February 2, 2013
    Report Date
    February 2, 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)(6) -THE DEALER REPORTED THAT THE M91 POWER WHEELCHAIR JOYSTICK WAS LOGGING ON AND INCREASING SPEED WITHOUT COMMAND. DURING ONE OF THESE EPISODES IT RAN INTO THE TV STAND, THE TV FELL OFF, HITTING PATIENT'S RIGHT KNEE, AND LANDING ON HIS LEFT FOOT. EMERGENCY MEDICAL ATTENTION WAS SOUGHT AS PATIENT SUSTAINED CUTS AND BROKEN BONES ON HIS LEFT FOOT. SHOULD WE RECEIVE ADDITIONAL INFORMATION, THIS FILE WILL BE REVIEWED, AND A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    45524 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M91

    Patients

    Seq Age Sex Outcome Treatment
    1 78 Other