BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3914202 · Received July 3, 2014

    Report

    Report Number
    1525712-2014-03461
    Event Type
    Malfunction
    Date Received
    July 3, 2014
    Date of Event
    May 31, 2014
    Report Date
    June 3, 2014
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER ALLEGES THAT THE CHAIR JUST STOPPED IN THE MIDDLE OF THE STREET.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    391053 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other