BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3112754 · Received May 14, 2013

    Report

    Report Number
    1525712-2013-03777
    Event Type
    Malfunction
    Date Received
    May 14, 2013
    Report Date
    April 17, 2013
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES LIGHTS BLINK AND SHUTS DOWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    212539 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN M51MPURD

    Patients

    Seq Age Sex Outcome Treatment
    1 Other