BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4122660 · Received September 26, 2014

    Report

    Report Number
    1525712-2014-06393
    Event Type
    Malfunction
    Date Received
    September 26, 2014
    Date of Event
    September 5, 2014
    Report Date
    September 8, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE STABILITY LOCK IS NOT WORKING PROPERLY AND THAT INTERMITTENTLY WHEN THE USER IS COMING DOWN RAMP THE LEFT WHEEL COMES OFF OF THE GROUND.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    602030 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDX3BASE

    Patients

    Seq Age Sex Outcome Treatment
    1 Other