BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3051673 · Received April 10, 2013

    Report

    Report Number
    1525712-2013-02726
    Event Type
    Malfunction
    Date Received
    April 10, 2013
    Report Date
    March 13, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) HAS BEEN INITIATED FOR THIS ISSUE. THE MALFUNCTION HAS NOT BEEN CONFIRMED.

    Description of Event or Problem · 1

    PROVIDER STATES END USER WAS DRIVING AND WENT OVER A THRESHOLD THE WELD ON THE WALKING BEAM BROKE, AND ALSO EFFECTED THE CYLINDER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    153675 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSIV-2

    Patients

    Seq Age Sex Outcome Treatment
    1 Other