BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4121219 · Received September 26, 2014

    Report

    Report Number
    1525712-2014-06352
    Event Type
    Malfunction
    Date Received
    September 26, 2014
    Report Date
    September 8, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER STATED THAT THEIR M94 POWER CHAIR CAME TO A DEAD STOP WHILE GOING UP HIS 22 FOOT RAMP, THROWING HIM OUT OF THE CHAIR. STATES WHEN HE HIT THE GROUND HE CUT UP HIS LEGS A LITTLE BIT BUT NO ATTENTION WAS NEEDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    601973 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M94

    Patients

    Seq Age Sex Outcome Treatment
    1 Other