BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3970385 · Received July 31, 2014

    Report

    Report Number
    1525712-2014-04215
    Event Type
    Malfunction
    Date Received
    July 31, 2014
    Report Date
    June 25, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    BOTTOM LIP ON ARM BASE WELD BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    447598 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSR-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other