BEUDAMED
    FDA Adverse Event Summary report: N

    MOTORIZED 3-WHEELED VEHICLE FOR OUTSIDE TRANSPORT

    MDR report key: 2972616 · Received February 21, 2013

    Report

    Report Number
    1531186-2013-00689
    Date Received
    February 21, 2013
    Report Date
    February 21, 2013
    Manufacturer
    C.T.M. HOMECARE PRODUCT, INC
    Product Code
    INI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(4). NO SERIOUS INJURY ALLEGED. MALFUNCTION ALLEGED. SCOOTER IS MAKING A CLICKING NOISE AND SURGING CAUSING THE SCOOTER TO JERK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    76958 MOTORIZED 3-WHEELED VEHICLE FOR OUTSIDE TRANSPORT 890.3800 INI C.T.M. HOMECARE PRODUCT, INC L-3R

    Patients

    Seq Age Sex Outcome Treatment
    1 Other