BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3894927 · Received June 25, 2014

    Report

    Report Number
    1525712-2014-03177
    Event Type
    Malfunction
    Date Received
    June 25, 2014
    Report Date
    May 27, 2014
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AK, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    END USER STATES THE RUBBER KNOB OF THE DEVICE HAS CAME OFF AND IS LOST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    370225 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other