BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI

    MDR report key: 4912404 · Received July 14, 2015

    Report

    Report Number
    1525712-2015-03862
    Event Type
    Malfunction
    Date Received
    July 14, 2015
    Report Date
    June 19, 2015
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    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

    WHILE CHARGING BATTERIES ON THIS WHEELCHAIR, THE JOYSTICK GOT DAMAGED. CAPACITOR C45 ON MAIN CIRCUIT BOARD BURNT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    455696 POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI WHEELCHAIR, POWERED ITI INVACARE TAYLOR STREET 3GAR

    Patients

    Seq Age Sex Outcome Treatment
    1 Other