BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3953062 · Received July 23, 2014

    Report

    Report Number
    1525712-2014-03942
    Event Type
    Malfunction
    Date Received
    July 23, 2014
    Report Date
    June 18, 2014
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATES THE TILT ACTUATOR IS BROKEN AT THE REAR WHERE IT ATTACHES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    430418 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other