BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3230095 · Received July 16, 2013

    Report

    Report Number
    1525712-2013-05798
    Event Type
    Malfunction
    Date Received
    July 16, 2013
    Date of Event
    June 22, 2013
    Report Date
    June 25, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE DEALER STATES THE CHIR HAS TIPPED OVER SEVERAL TIMES. HE STATES DOWN HILL ONCE, ((B)(4)) AND ONCE OVER A CURB ((B)(4)). THE DEALER THINKS IT'S THE DRIVERS ERROR. THE DEALER STATES NO ABNORMAL DAMAGE, BUT THE CUSTOMER IS NOT THE BEST DRIVER AND HAS DAMAGED ARM PADS FROM TIPPING OVER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    328486 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M91

    Patients

    Seq Age Sex Outcome Treatment
    1 Other