BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3207720 · Received July 5, 2013

    Report

    Report Number
    1525712-2013-05416
    Event Type
    Malfunction
    Date Received
    July 5, 2013
    Report Date
    June 13, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES THE SCREW WAS BROKEN OFF IN Q-LINK MOUNT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    307404 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TXSP-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other