BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4213434 · Received October 30, 2014

    Report

    Report Number
    1525712-2014-07452
    Event Type
    Malfunction
    Date Received
    October 30, 2014
    Report Date
    October 13, 2014
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PER END USER, THE CASTERS AND WHEELS ARE WORN AND NEED REPLACED

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    695315 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other