BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3033921 · Received April 3, 2013

    Report

    Report Number
    1525712-2013-02536
    Event Type
    Malfunction
    Date Received
    April 3, 2013
    Report Date
    March 7, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATED THAT THE CHAIR HAS NOT ACTED UP FOR HIM. PROVIDER STATES THE USER SAYS THE CHAIR STOPS AND THE WRENCH FLASHES. ENDUSER HAD NO OTHER INFORMATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    137182 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M61R

    Patients

    Seq Age Sex Outcome Treatment
    1 Other