BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4092969 · Received September 16, 2014

    Report

    Report Number
    1525712-2014-05886
    Event Type
    Malfunction
    Date Received
    September 16, 2014
    Date of Event
    August 22, 2014
    Report Date
    August 22, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER ALLEGES THE TAB WASHER IS BREAKING ON THE BOLT OF THE MOTOR ON A (B)(4) POWER CHAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    573697 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M91-TS

    Patients

    Seq Age Sex Outcome Treatment
    1 Other