BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3123099 · Received May 21, 2013

    Report

    Report Number
    1525712-2013-03990
    Event Type
    Malfunction
    Date Received
    May 21, 2013
    Report Date
    April 25, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE DEALER REPORTED THAT THE WIRES WERE PULLED OUT OF THE LEG MOTOR ON THE POWER CHAIR. THIS ISSUE COULD CAUSE THE LEG REST TO BE UNSTABLE AND COULD CAUSE ELECTRIC SHOCK TO THE USER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    223458 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GTQ3-MCG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other