BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4213490 · Received October 30, 2014

    Report

    Report Number
    1525712-2014-07456
    Event Type
    Malfunction
    Date Received
    October 30, 2014
    Date of Event
    October 25, 2014
    Report Date
    October 28, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT WHILE THE (B)(4) POWER CHAIR WAS IN DRIVE MODE, WITH MOTOR ENGAGED, THE LEFT BRAKE WAS NOT WORKING PROPERLY, WAS PULLING TO THE RIGHT. THE MOTOR BRAKE LEVER WAS BENT WHICH PREVENTED THE DRIVE MODE TO BE COMPLETELY ENGAGED. DEALER BENT THE BRAKE LEVER BACK AND THE CHAIR IS NOW FUNCTIONING PROPERLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    695510 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET 3GTQ3

    Patients

    Seq Age Sex Outcome Treatment
    1 Other