BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4111049 · Received September 23, 2014

    Report

    Report Number
    3008262382-2014-01173
    Event Type
    Malfunction
    Date Received
    September 23, 2014
    Date of Event
    August 29, 2014
    Report Date
    August 29, 2014
    Manufacturer
    INVACARE REHABILITATION EQUIP
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PER DEALER, THE CONSUMER CALLED, AND SAID THE CHAIR LURCHED FORWARD AND HIT THE WALL; CONSUMER CALLED DEALER AND SAID THE CHAIR WAS FINE NOW AND NOT TO BOTHER COMING OUT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    591546 POWERED WHEELCHAIR 890.3860 ITI INVACARE REHABILITATION EQUIP AIRPTMBDY20

    Patients

    Seq Age Sex Outcome Treatment
    1 Other