BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3821574 · Received May 20, 2014

    Report

    Report Number
    1525712-2014-02518
    Event Type
    Malfunction
    Date Received
    May 20, 2014
    Date of Event
    April 5, 2014
    Report Date
    April 7, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PER ENDUSER, THE CHAIR TOOK OFF WHICH CAUSED DAUGHTER TO END UP ON THE FLOOR AND THE CHAIR WAS ROLLING OVER HER FOOT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    299270 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 46 Other