BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3180991 · Received June 20, 2013

    Report

    Report Number
    1525712-2013-04872
    Event Type
    Malfunction
    Date Received
    June 20, 2013
    Date of Event
    May 10, 2013
    Report Date
    June 19, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DE, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). PER RESPONSE FROM PROVIDER (RECEIVED ON (B)(4) 2013) THE END USER'S POWERCHAIR WAS GOING INTO CIRCLES. NO INJURY OR MEDICAL INTERVENTION REPORTED.

    Description of Event or Problem · 1

    PER PROVIDER THE END USER'S, WHILE AT THE DAYCARE, POWERCHAIR WAS GOING INTO CIRCLES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    280744 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other