FDA Adverse Event
Malfunction
Summary report: N
POWERED WHEELCHAIR
MDR report key: 3230283
·
Received July 16, 2013
Report
- Report Number
- 1525712-2013-05807
- Event Type
- Malfunction
- Date Received
- July 16, 2013
- Report Date
- June 25, 2013
- Manufacturer
- INVACARE TAYLOR STREET
- Product Code
- ITI
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TX, US
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Description of Event or Problem · 1
DLR STATES ON SN (B)(4) THAT THE CUSTOMER BUMPED INTO SOMETHING AND BROKE THE LNX ACTUATOR MOTOR ASSEMBLY LS7964.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 328634 | POWERED WHEELCHAIR | 890.3860 | ITI | INVACARE TAYLOR STREET | FDX-MCG |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |