BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4111282 · Received September 23, 2014

    Report

    Report Number
    1525712-2014-06227
    Event Type
    Malfunction
    Date Received
    September 23, 2014
    Date of Event
    September 4, 2014
    Report Date
    September 4, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER ALLEGES THAT HE INSTALLED THE REPLACEMENT LEFT MOTOR ON THE M71 POWER CHAIR AND IT RAN FOR A LITTLE AND THEN JUST STOPPED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    590710 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M71

    Patients

    Seq Age Sex Outcome Treatment
    1 Other