MAUDE Adverse Event Report: INVACARE TAYLOR STREET PRONTO M41 BLUE BASE 9153645762; WHEELCHAIR, POWERED

Model Number CUSTOMPOWER

Device Problems Detachment Of Device Component (1104); Mechanical Problem (1384); Sticking (1597)

Patient Problem No Information (3190)

Event Type  malfunction  

Manufacturer Narrative

Mdr is being submitted as a result of a retrospective complaint review.

Event Description

Dealer stated the chair is doing circles.If you disengage it the left side rolls, but the rights side doesn't move at all.

• Brand Name: PRONTO M41 BLUE BASE 9153645762
• Type of Device: WHEELCHAIR, POWERED
• Manufacturer (Section D): INVACARE TAYLOR STREET; 1200 taylor street; elyria OH 44036
• Manufacturer (Section G): INVACARE TAYLOR STREET; 1200 taylor street; elyria OH 44036
• Manufacturer Contact: kevin guyton ; one invacare way; elyria, OH 44035 ; 8003336900
• MDR Report Key: 5685132
• MDR Text Key: 46190213
• Report Number: 1525712-2016-01510
• Device Sequence Number: 1
• Product Code: ITI
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor
• Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date: 08/28/2012

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/27/2016
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: CUSTOMPOWER
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/12/2012
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 08/28/2012
• Was Device Evaluated by Manufacturer?: Yes
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1