BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4090472 · Received September 15, 2014

    Report

    Report Number
    1525712-2014-05869
    Event Type
    Malfunction
    Date Received
    September 15, 2014
    Date of Event
    August 19, 2014
    Report Date
    August 22, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KY, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE DEALER ALLEGES THE ELR IS BROKEN AT THE BOTTOM OF THE CYLINDER ON A M91-TS POWER CHAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    570275 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M91-TS

    Patients

    Seq Age Sex Outcome Treatment
    1 Other