BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3935964 · Received July 15, 2014

    Report

    Report Number
    1525712-2014-03705
    Event Type
    Malfunction
    Date Received
    July 15, 2014
    Date of Event
    June 2, 2014
    Report Date
    June 9, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    FACILITY ADVISED LEFT FOOTPLATE IS BROKEN. NO INJURY. FACILITY COULD NOT PROVIDE ANY FURTHER INFORMATION. (B)(6)

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    414435 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M94-C

    Patients

    Seq Age Sex Outcome Treatment
    1 Other