BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4013696 · Received August 15, 2014

    Report

    Report Number
    1525712-2014-04811
    Event Type
    Injury
    Date Received
    August 15, 2014
    Date of Event
    April 17, 2014
    Report Date
    August 8, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER BACK WHEELS WERE 3 OFF GROUND WHEN GOING IN REVERSE UP THE RAMP INTO VAN. CUSTOMER REPORTS IT HELPED SOME BUT THE WHEELS STILL ARE ABOUT 1 1/2 INCHES OR MORE OFF OF GROUND IN MOST CIRCUMSTANCES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    489276 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention