BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4090856 · Received September 15, 2014

    Report

    Report Number
    1525712-2014-05871
    Event Type
    Malfunction
    Date Received
    September 15, 2014
    Report Date
    August 20, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE PROVIDER ALLEGES THE LEFT MOTOR IS SLIPPING ON A (B)(4) POWER CHAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    568866 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GSEAT-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other