BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 3981260 · Received August 5, 2014

    Report

    Report Number
    1525712-2014-04405
    Event Type
    Malfunction
    Date Received
    August 5, 2014
    Date of Event
    June 29, 2014
    Report Date
    June 30, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    CONSUMER STATES THAT YESTERDAY SHE WAS GOING OUTSIDE AND THE CHAIR LOCKED UP, WOULDN'T MOVE BUT TORE THE BOTTOM HINGE OF THE DOOR OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    458567 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GTQ3-MCG

    Patients

    Seq Age Sex Outcome Treatment
    1 55 Other