BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3233208 · Received July 18, 2013

    Report

    Report Number
    1525712-2013-05909
    Event Type
    Malfunction
    Date Received
    July 18, 2013
    Report Date
    June 27, 2013
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UT, US
    Reporter Occupation
    HOSPITAL SERVICE TECHNICIAN

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES CONTROLLER FAULT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    333861 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDX5

    Patients

    Seq Age Sex Outcome Treatment
    1 Other