BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4202178 · Received October 27, 2014

    Report

    Report Number
    1525712-2014-07291
    Event Type
    Malfunction
    Date Received
    October 27, 2014
    Date of Event
    October 7, 2014
    Report Date
    October 7, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    THE DEALER STATES THAT THE UPPER SUPPORT ON THE POWER ELEVATING LEGREST BENT AND PART OF IT IS BROKEN UP INSIDE. WHEN IT BENT, IT ALSO BENT THE ACTUATOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    683867 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TDXSP-MCG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other