BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3944329 · Received July 18, 2014

    Report

    Report Number
    1525712-2014-03796
    Event Type
    Malfunction
    Date Received
    July 18, 2014
    Report Date
    June 13, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NE, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES THAT THE CONSUMER WAS GOING DOWN HIS RAMP AND NOTICED THE CHAIR TIP SLIGHTLY FORWARD BECAUSE THE GAS LOCKING CYLINDER WAS LEAKING. NO ADDITIONAL INFORMATION PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    421597 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP

    Patients

    Seq Age Sex Outcome Treatment
    1 Other