BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERED WHEELCHAIR

    MDR report key: 4241398 · Received November 10, 2014

    Report

    Report Number
    3008262382-2014-01927
    Event Type
    Malfunction
    Date Received
    November 10, 2014
    Date of Event
    November 2, 2014
    Report Date
    November 7, 2014
    Manufacturer
    INVACARE REHABILITATION EQUIP
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    END USER REPORTED THAT HIS M41SRR POWER CHAIR TOOK OFF, PINNED HIS WIFE TO A WALL. NO ALLEGED INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    721718 POWERED WHEELCHAIR 890.3860 ITI INVACARE REHABILITATION EQUIP M41SRR

    Patients

    Seq Age Sex Outcome Treatment
    1 Other