BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3821674 · Received May 20, 2014

    Report

    Report Number
    1525712-2014-02537
    Event Type
    Malfunction
    Date Received
    May 20, 2014
    Date of Event
    February 16, 2014
    Report Date
    April 8, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    R51 POWER WHEEL CHAIR VEERED TO THE LEFT AND CAUSED HER LEFT FOOT TO GO THROUGH A WALL. END USER SUSTAINED MINOR SCRATCHES. NO MEDICAL ATTENTION WAS SOUGHT FOR THIS INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    300781 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET R51

    Patients

    Seq Age Sex Outcome Treatment
    1 43 Other