BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3884373 · Received June 19, 2014

    Report

    Report Number
    1525712-2014-03048
    Event Type
    Malfunction
    Date Received
    June 19, 2014
    Report Date
    May 20, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    Narratives

    Description of Event or Problem · 1

    END USERS SON REPORTED THAT THE COVER FOR THE ELECTRONICS ON HIS MOTHERS 3GTQ-TS POWER CHAIR BROKE. THE WIRING FOR THE ELECTRONICS IS STICKING OUT AND THE SON IS WORRIED THAT THE WIRING CAN BE RIPPED OUT SHOULD IT GET CAUGHT ON SOMETHING .

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    361887 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GTQ-TS

    Patients

    Seq Age Sex Outcome Treatment
    1 Other