BEUDAMED
    FDA Adverse Event Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3123292 · Received May 21, 2013

    Report

    Report Number
    1525712-2013-04029
    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
    WI, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    PER DEALER, THE CHAIR ROLLED BACKWARD DOWN THE END USER'S RAMP WHICH WAS TOO SHORT FOR THE DOOR. WHEN ATTEMPTING TO GO OVER A 2" DISCREPANCY IN HEIGHT, AT FULL SPEED, THE CHAIR LIFTED UP AND ROLLED BACKWARD. NO INJURIES, ENTRAPMENT OR MEDICAL INTERVENTION OCCURRED PER DEALER.

    Description of Event or Problem · 1

    DEALER ALLEGES THE CHAIR ROLLED OVER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    224620 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other