BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI

    MDR report key: 4556290 · Received March 2, 2015

    Report

    Report Number
    1525712-2015-01497
    Event Type
    Malfunction
    Date Received
    March 2, 2015
    Report Date
    February 20, 2015
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    LA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER STATES THIS IS THE 3RD SET OF ENGAGEMENT KNOBS THAT THE 3 SEATED PINS HAVE SOMEHOW WORKED THEMSELVES OUT OF. WE ARE REPLACING A COMPLETE WHEEL ASSEMBLY ON BOTH SIDES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    144457 POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI WHEELCHAIR, POWERED ITI INVACARE TAYLOR STREET 3GTQ-CG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other