BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4171069 · Received October 14, 2014

    Report

    Report Number
    1525712-2014-06974
    Event Type
    Malfunction
    Date Received
    October 14, 2014
    Report Date
    September 25, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATES CHAIR HAS NOT WORKED FOR ABOUT A MONTH. NO POWER, NOT SURE ABOUT BATTERIES IF GOOD OR NOT. CUSTOMER HAD BRAKES REMOVED OR RELEASED SO SHE CAN BE PUSHED AROUND IN THE HOUSE. CUSTOMER STATES THAT THERE IS BATTERY ACID ON HER CARPET. THE CARPET IS RUINED IT IS ABOUT THE SIZE OF HER CHAIR. CUSTOMER LIVES IN A RENTAL HOME AND WILL HAVE TO PAY FOR IT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    651762 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M51PMPURD

    Patients

    Seq Age Sex Outcome Treatment
    1 Other