BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3071973 · Received April 22, 2013

    Report

    Report Number
    1525712-2013-03171
    Event Type
    Malfunction
    Date Received
    April 22, 2013
    Report Date
    March 27, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATES CUSTOMER BROKE THE BOLT THAT HOLDS ON THE SEAT POST TO THE BASE FRAME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    172356 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M51PSEMIRED

    Patients

    Seq Age Sex Outcome Treatment
    1 Other