BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3800065 · Received May 8, 2014

    Report

    Report Number
    3004493922-2014-00667
    Event Type
    Malfunction
    Date Received
    May 8, 2014
    Date of Event
    April 9, 2014
    Report Date
    April 10, 2014
    Manufacturer
    INVACARE SUZHOU
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    (B)(4) POWER WHEEL CHAIR MOTOR BRAKE IS SMOKING. ALSO HALF STUCK CAUSING LEFT SIDE OF CHAIR NOT TO MOVE AND GO IN CIRCLES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    278657 POWERED WHEELCHAIR 890.3860 ITI INVACARE SUZHOU M51PSEMIBLUE

    Patients

    Seq Age Sex Outcome Treatment
    1 58 Other