BEUDAMED
    FDA Adverse Event Summary report: N

    MOTORIZED 3-WHEELED VEHICLE FOR OUTSIDE TRANSPORT

    MDR report key: 4187498 · Received October 21, 2014

    Report

    Report Number
    1531186-2014-04970
    Date Received
    October 21, 2014
    Date of Event
    September 30, 2014
    Report Date
    September 30, 2014
    Manufacturer
    C.T.M. TAIWAN
    Product Code
    INI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PER PROVIDER BRAKES NOT WORKING (MOTOR (12 KM/H) RHINO 2 9153654155). ADDITIONAL ASSOCIATED REPORTABLE MALFUNCTION - PER PROVIDER BRAKES NOT WORKING (CONTROLLER, RHINO 2 (110A) PEGASUS 9153653519).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    666853 MOTORIZED 3-WHEELED VEHICLE FOR OUTSIDE TRANSPORT 890.3800 INI C.T.M. TAIWAN PEGASUS3S-8

    Patients

    Seq Age Sex Outcome Treatment
    1 Other