BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3123213 · Received May 21, 2013

    Report

    Report Number
    1525712-2013-04002
    Event Type
    Malfunction
    Date Received
    May 21, 2013
    Date of Event
    March 1, 2013
    Report Date
    April 26, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    CONSUMER ALLEGES HER WHEEL BUSTED ON HER POWER CHAIR WHILE RIDING DOWN THE STREET AND HITTING A BUMP ON THE CONCRETE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    224272 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP

    Patients

    Seq Age Sex Outcome Treatment
    1 Other