BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3071733 · Received April 22, 2013

    Report

    Report Number
    1525712-2013-03127
    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
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER STATES CHAIR MOVED UNEXPECTEDLY AND BROKE THE PLASTIC STRAW THAT GOES TO THE COMPUTER MOUSE, ALSO JABBED END USER IN THE FACE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    171118 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GTQ3-MCG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other