BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3178563 · Received June 19, 2013

    Report

    Report Number
    1834066-2013-00006
    Event Type
    Malfunction
    Date Received
    June 19, 2013
    Report Date
    May 23, 2013
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    THE SERIAL NUMBER PROVIDED HAS NOT BEEN CONFIRMED.

    Additional Manufacturer Narrative · 1

    PLEASE NOTE, MDR 1834066-2013-00006, WAS INADVERTENTLY SUBMITTED UNDER THE INCORRECT MANUFACTURER REGISTRATION NUMBER. THE CORRECT MANUFACTURER REGISTRATION NUMBER IS (B)(4).

    Description of Event or Problem · 1

    PROVIDER STATES STALLS OUT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    278190 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other