BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3090782 · Received May 2, 2013

    Report

    Report Number
    1525712-2013-03471
    Event Type
    Malfunction
    Date Received
    May 2, 2013
    Report Date
    April 8, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES THERE IS A BROKEN LEVER ON MOTOR AND IS SEIZED ON MOTOR SHAFT. RMA QT ISSUED: (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    193021 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSI-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other