BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3163437 · Received June 11, 2013

    Report

    Report Number
    1525712-2013-04532
    Event Type
    Malfunction
    Date Received
    June 11, 2013
    Report Date
    May 14, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    (B)(6) ALLEGES THAT SHE WAS GETTING ON PUBLIC TRANSPORTATION AND WHEN SHE SHUT HER CHAIR OFF AND WENT TO TURN IT BACK ON IT REARED UPWARDS AND THEN SLAMMED DOWN. THIS IS THE 2ND TIME THAT THIS HAS HAPPENED - HAPPENED IN (B)(6) 2012 AND THEY REPLACED HER ELECTRONICS. SCARED TO GET BACK IN HER CHAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    263756 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET R51LX

    Patients

    Seq Age Sex Outcome Treatment
    1 69 Other