BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4222718 · Received November 4, 2014

    Report

    Report Number
    1525712-2014-07591
    Event Type
    Malfunction
    Date Received
    November 4, 2014
    Date of Event
    October 23, 2014
    Report Date
    October 23, 2014
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    DEALER STATED THAT WHEN THEIR TECHNICIAN PLUGGED IN THE UNKNOWN POWER CHAIR IT TOOK OFF BACKWARD HITTING THE TECH IN THE RIBS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    707749 POWERED WHEELCHAIR 890.3860 ITI INVACARE TAYLOR STREET UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 Other