BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4220262 · Received November 3, 2014

    Report

    Report Number
    1525712-2014-07538
    Event Type
    Malfunction
    Date Received
    November 3, 2014
    Report Date
    October 9, 2014
    Manufacturer
    UNKNOWN
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER STATES THAT LAST NIGHT WHEN COMING IN FROM GETTING THE MAIL AND IT WOULD NOT MAKE IT UP THE INCLINE. STATES THAT SHE HAD A BOTTLE OF OLIVE OIL THAT FELL OUT OF HER LAP AND LOST IT. THEN LATER THAT NIGHT FOUND IT HAD FALLEN UNDERNEATH THE CHAIR AND MAY HAVE PULLED OUT A WIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    702051 POWERED WHEELCHAIR 890.3860 ITI UNKNOWN M41BB

    Patients

    Seq Age Sex Outcome Treatment
    1 Other