FDA Adverse Event
Malfunction
Summary report: N
POWERED WHEELCHAIR
MDR report key: 4093775
·
Received September 16, 2014
Report
- Report Number
- 1525712-2014-05908
- Event Type
- Malfunction
- Date Received
- September 16, 2014
- Report Date
- August 22, 2014
- Manufacturer
- INVACARE TAYLOR STREET
- Product Code
- ITI
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA, US
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Description of Event or Problem · 1
PER DEALER, ADVISED LATERAL BROKE IN HALF CAUSING ONE PIECE TO STAY ON THE 3GTQ3-CG POWER CHAIR
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 572742 | POWERED WHEELCHAIR | 890.3860 | ITI | INVACARE TAYLOR STREET | 3GTQ3-CG |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |