BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4222641 · Received November 4, 2014

    Report

    Report Number
    1525712-2014-07587
    Event Type
    Malfunction
    Date Received
    November 4, 2014
    Report Date
    October 15, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES SEAT FRAME IS BROKE AT WELD ON LEFT SIDE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    705726 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET TA4T

    Patients

    Seq Age Sex Outcome Treatment
    1 Other