BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3932553 · Received July 14, 2014

    Report

    Report Number
    1525712-2014-03644
    Event Type
    Malfunction
    Date Received
    July 14, 2014
    Date of Event
    June 4, 2014
    Report Date
    June 9, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE PROVIDER THAT THE TDX4 POWER CHAIR CASTERS ARE WORN OUT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    409925 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDX4

    Patients

    Seq Age Sex Outcome Treatment
    1 Other