BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3896971 · Received June 26, 2014

    Report

    Report Number
    1525712-2014-03200
    Event Type
    Malfunction
    Date Received
    June 26, 2014
    Date of Event
    May 5, 2014
    Report Date
    May 27, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PER PROVIDER THE CHAIR WILL QUICKLY STOP AND THEN CONTINUE WITHOUT GIVING ANY FAULT CODES. PROVIDER STATES THIS HAPPENS AFTER ABOUT 5 MINUTES OF DRIVING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    374177 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSI-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other