BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3267722 · Received August 6, 2013

    Report

    Report Number
    9615350-2013-00018
    Event Type
    Malfunction
    Date Received
    August 6, 2013
    Report Date
    July 23, 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

    Additional Manufacturer Narrative · 1

    (B)(4) - FOLLOW UP #001. INITIAL (B)(4) ISSUED MFR. REPORT # 9615350-2013-00018, INDICTING THE BRAND NAME AS WHEELCHAIR COMPONENTS, THE CORRECT NAME IS POWERED WHEELCHAIR; THE COMMON DEVICE NAME AS 890.3920, THE CORRECT DEVICE IS 890.3860; THE MANUFACTURER AS MOTION CONCEPTS WHEN THE MANUFACTURER IS INVACARE TAYLOR STREET. THE FDA REGISTRATION NUMBER WAS REPORTED AS (B)(4) WHEN IN FACT IT IS (B)(4) FOR INVACARE.

    Description of Event or Problem · 1

    PROVIDER STATES BACK SHELL IS CRACKED BY LATERAL BEND.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    367138 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET MPB-V

    Patients

    Seq Age Sex Outcome Treatment
    1 Other