BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 2991893 · Received March 6, 2013

    Report

    Report Number
    1525712-2013-01720
    Event Type
    Malfunction
    Date Received
    March 6, 2013
    Report Date
    March 11, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DLR STATES ON SN (B)(4) THAT THE ELEVATE ACTUATOR WHERE IT MOUNTS TO THE BASE THE BOLTS ARE COMPLETELY SHEARED OFF AND THE BATTERY BOX IS BENT LS7964

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    95272 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDX3-PS

    Patients

    Seq Age Sex Outcome Treatment
    1 Other