BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4090892 · Received September 15, 2014

    Report

    Report Number
    1525712-2014-05875
    Event Type
    Malfunction
    Date Received
    September 15, 2014
    Report Date
    August 25, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER SPOKE WITH (B)(6) IN TECH SERVICE EXT (B)(4) TO ADVISE THAT THE LEFT MOTOR IS FROZEN AND WILL NOT MOVE. PROVIDER STATES THE BRAKE WILL NOT DISENGAGE. PROVIDER HUNG UP BEFORE ANY ADDITIONAL INFORMATION COULD BE OBTAINED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    568904 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M50

    Patients

    Seq Age Sex Outcome Treatment
    1 Other