FDA Adverse Event
Malfunction
Summary report: N
POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI
MDR report key: 4902208
·
Received July 9, 2015
Report
- Report Number
- 1525712-2015-03809
- Event Type
- Malfunction
- Date Received
- July 9, 2015
- Report Date
- June 16, 2015
- Manufacturer
- INVACARE TAYLOR STREET
- Product Code
- ITI
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MA, US
- Reporter Occupation
- MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE
Narratives
Additional Manufacturer Narrative · 1
SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE A SUPPLEMENTAL RECORD WILL BE FILED.
Description of Event or Problem · 1
THE CHAIR IS MAKING A SQUEAKING NOISE AND MISSING A HUB SPACER.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 444723 | POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI | WHEELCHAIR, POWERED | ITI | INVACARE TAYLOR STREET | 3GTQ3-CG |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Other |