BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3903163 · Received June 30, 2014

    Report

    Report Number
    1525712-2014-03282
    Event Type
    Malfunction
    Date Received
    June 30, 2014
    Date of Event
    May 29, 2014
    Report Date
    May 29, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PER PROVIDER DEALER STATED THE END USER CAME IN WITH THE ARM OF HIS CHAIR AND STATED THE TUBE THAT ATTACHES TO THE SIDE PANEL BROKE ON THE RIGHT SIDE. DEALER STATED THERE WERE NO INJURIES PERTAINING TO THE INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    380016 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GTQSP

    Patients

    Seq Age Sex Outcome Treatment
    1 Other