BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4090268 · Received September 15, 2014

    Report

    Report Number
    1525712-2014-05867
    Event Type
    Malfunction
    Date Received
    September 15, 2014
    Report Date
    August 22, 2014
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PER CUSTOMER STATES CHAIR WAS VEERING OFF TO THE RIGHT AND LIGHTS BLINKING 3 TIMES AND CHAIR SHUT DOWN. CUSTOMER WAS ABANDONED ON SIDE OF ROAD AND HAD TO BE PICKED UP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    568408 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other