BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3191534 · Received June 26, 2013

    Report

    Report Number
    1525712-2013-05039
    Event Type
    Malfunction
    Date Received
    June 26, 2013
    Report Date
    May 31, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER ALLEGES THAT THE BASEMENT WALLS HAVE QUARTER SIZED HOLES IN THEM AS A RESULT OF THE CHAIR TAKING OFF ON ITS OWN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    291318 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP=CG

    Patients

    Seq Age Sex Outcome Treatment
    1 30 Other