BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3071729 · Received April 22, 2013

    Report

    Report Number
    1525712-2013-03123
    Event Type
    Malfunction
    Date Received
    April 22, 2013
    Report Date
    March 26, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER STATES AFTER HAVING CHAIR SERVICED FROM MED-SOUTH CHAIR HAS A JUMP IN IT WHEN GOING ON SMALL CRACKS CHAIR JOLTS VERY HARD AFTER GOING OVER A THRESHOLD AND HAS THROWN HIM OUT OF THE CHAIR. CONSUMER STATES IT SEEMS TO HAVE SOME TYPE OF LOCK ON IT AND SHUTS DOWN. CUSTOMER HAS HAD SOME BRUISING LEG ALSO HAD SOME PROPERTY DAMAGE DUE TO CHAIR JOLTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    171934 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSIV-HD

    Patients

    Seq Age Sex Outcome Treatment
    1 53 Other