BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3811738 · Received May 15, 2014

    Report

    Report Number
    1525712-2014-02475
    Event Type
    Malfunction
    Date Received
    May 15, 2014
    Date of Event
    September 11, 2013
    Report Date
    April 9, 2014
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATE THE LEFT MOTOR IS LEAKING GREASE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    290866 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN M51

    Patients

    Seq Age Sex Outcome Treatment
    1 Other