BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI

    MDR report key: 5066996 · Received September 10, 2015

    Report

    Report Number
    1525712-2015-04521
    Event Type
    Malfunction
    Date Received
    September 10, 2015
    Date of Event
    July 8, 2015
    Report Date
    August 13, 2015
    Manufacturer
    INVACARE TAYLOR STREET
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, 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

    PROVIDER STATES THE CASTER HAS FALLEN OFF AND MAKING A NOISE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    599174 POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI WHEELCHAIR, POWERED ITI INVACARE TAYLOR STREET 3GTQ-MCG

    Patients

    Seq Age Sex Outcome Treatment
    1 Other