BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3143714 · Received June 3, 2013

    Report

    Report Number
    1525712-2013-04298
    Event Type
    Malfunction
    Date Received
    June 3, 2013
    Report Date
    May 7, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) - FOLLOW UP #001. INITIAL (B)(4) ISSUED MFR. REPORT # 1525712-2013-04298. THE H TAB, DEVICE MANUFACTURERS ONLY, WAS NOT COMPLETED. IT HAS NOW BEEN COMPLETED IN ITS ENTIRETY.

    Description of Event or Problem · 1

    PER PROVIDER, THE JOY STICK IS SURGING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    243427 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M51PR

    Patients

    Seq Age Sex Outcome Treatment
    1 Other