BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4202718 · Received October 27, 2014

    Report

    Report Number
    1525712-2014-07305
    Event Type
    Malfunction
    Date Received
    October 27, 2014
    Report Date
    October 7, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER SPOKE WITH (B)(4) IN CUSTOMER SERVICE EXT (B)(4) TO ADVISE THAT THE RIGHT TORSION SPRING IS SLOPPY ON THIS CHAIR. PROVIDER HUNG UP BEFORE ANY ADDITIONAL INFORMATION COULD BE OBTAINED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    683764 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET M91R

    Patients

    Seq Age Sex Outcome Treatment
    1 Other