BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3163578 · Received June 11, 2013

    Report

    Report Number
    1525712-2013-04564
    Event Type
    Malfunction
    Date Received
    June 11, 2013
    Report Date
    May 15, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    SERIAL NUMBER GIVEN, (B)(4), WAS UNABLE TO BE VERIFIED. IT IS MOST PROBABLY (B)(4), A 3GTSP. THE PART NUMBER GIVEN, 1179217, IS ASSOCIATED WITH EITHER THE STORM SERIES 3G OR TDXSP POWER CHAIRS, BOTH MANUFACTURED BY INVACARE (B)(4).

    Description of Event or Problem · 1

    PROVIDER STATES CHAIR HAD INTERMITTENT (RT AND LF) MOTOR LOCKING UP AND SHOWING MOTOR LOCK UP ON THE JOYSTICK SCREEN 3 TIMES DAY PER RB TECH. ITEM NUMBER (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    264013 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other