BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3039293 · Received April 5, 2013

    Report

    Report Number
    1525712-2013-02622
    Event Type
    Malfunction
    Date Received
    April 5, 2013
    Report Date
    March 11, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES RIGHT MOTOR QUIT WORKING. MOTOR KIT - 1163475 FOR RIGHT GEARBOX.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    140486 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M51PR

    Patients

    Seq Age Sex Outcome Treatment
    1 Other