FDA Adverse Event
Malfunction
Summary report: N
POWERED WHEELCHAIR
MDR report key: 3100757
·
Received May 8, 2013
Report
- Report Number
- 1525712-2013-03623
- Event Type
- Malfunction
- Date Received
- May 8, 2013
- Report Date
- April 12, 2013
- Manufacturer
- UNKNOWN
- Product Code
- ITI
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MA, US
- Reporter Occupation
- PATIENT
Narratives
Description of Event or Problem · 1
THE CONSUMER REPORTED THAT THE POWER CHAIR WAS LEAKING GREASE / OIL. THIS ISSUE COULD CAUSE THE USER TO SLIP AND FALL.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 201025 | POWERED WHEELCHAIR | 890.3860 | ITI | UNKNOWN | M51 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 57 | Other |