BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3981233 · Received August 5, 2014

    Report

    Report Number
    3008262382-2014-00487
    Event Type
    Malfunction
    Date Received
    August 5, 2014
    Date of Event
    June 23, 2014
    Report Date
    June 25, 2014
    Manufacturer
    INVACARE REHABILITATION EQUIP
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PER PROVIDER THE LEFT MOTOR STALLS, THEN JERKS UNDER LOAD CAUSING CHAIR TO GO TO ONE SIDE AND MAKE A NOISE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    458155 POWERED WHEELCHAIR 890.3860 ITI INVACARE REHABILITATION EQUIP M41SR20R

    Patients

    Seq Age Sex Outcome Treatment
    1 Other