BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3183321 · Received June 21, 2013

    Report

    Report Number
    1525712-2013-04920
    Event Type
    Malfunction
    Date Received
    June 21, 2013
    Report Date
    May 28, 2013
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER ADVISED SCREW CAME OFF AND WAS LOST, DRIVE WHEEL FELL OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    283110 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN 1023260

    Patients

    Seq Age Sex Outcome Treatment
    1 Other