BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI

    MDR report key: 4973084 · Received August 5, 2015

    Report

    Report Number
    1525712-2015-04171
    Event Type
    Malfunction
    Date Received
    August 5, 2015
    Report Date
    July 14, 2015
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, 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

    THEN THEY CONNECTED EACH ONE INDIVIDUALLY AND EVENTUALLY THE S4WSB DID NOT SHOW UP AS A CONNECTED DEVICE AND WHEN THEY NOTICED THE CABLE WAS PINCHED AND ARCING. NO INJURIES REPORTED JUST THAT THE CHAIR WOULD NOT TURN ON FOR A BIT. DEALER ALSO REQUESTED A NEW PWH CABLE BECAUSE IT WAS WORN AND FRAYED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    515939 POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI WHEELCHAIR, POWERED ITI INVACARE TAYLOR STREET 3GTQ3-MCG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other