BEUDAMED
    FDA Adverse Event Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3960603 · Received July 28, 2014

    Report

    Report Number
    1525712-2014-04017
    Date Received
    July 28, 2014
    Date of Event
    June 15, 2014
    Report Date
    June 19, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE END USER STATED THAT HER SLEEVE CAUGHT THE JOY STICK MOVED CHAIR FORWARD DAMAGING BATHROOM PLUMBING AND SINK CAUSING ALSO BRUISING HER ON HER WRIST. THE JOYSTICK SPUN TO THE SIDE. HER BROTHER CORRECTED THE JOYSTICK. PROVIDER HAS NEW JOYSTICK ON ORDER UNDER RECALL. PIPES WERE KNOCKED LOSE AND SOME FLOODING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    439484 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GRX-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other