MAUDE Adverse Event Report: INVACARE TAYLOR STREET POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI; WHEELCHAIR, POWERED

Model Number 3GRQSP

Device Problems Loss of Power (1475); Sticking (1597); Mechanics Altered (2984)

Patient Problem No Information (3190)

Event Type  malfunction  

Event Description

The dealer states that the consumer advised them that they had charged the chair overnight and while using it today the chair just stopped dead after a short amount of time.The dealer states that the chair will slow down and not turn left.

Manufacturer Narrative

(b)(4).Return evaluation received 7.10.2015.Conclusion: tested fully functional.Unit missing knob, skirt, and washer.The boot is pushed down on inductive shaft exposing the spring, washer found near centering mechanism of inductive.

Event Description

The dealer states that the consumer advised them that they had charged the chair overnight and while using it today the chair just stopped dead after a short amount of time.The dealer states that the chair will slow down and not turn left.

Manufacturer Narrative

Should additional information become available a supplemental record will be filed.

• Brand Name: POWER CHAIR 20 WIDE BY 18 DEEP FOR PMI
• 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: 4877314
• MDR Text Key: 6074087
• Report Number: 1525712-2015-03608
• 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,Followup
• Report Date: 07/10/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: 3GRQSP
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/10/2015
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 07/10/2015
• Initial Date FDA Received: 06/30/2015
• Supplement Dates Manufacturer Received: Not provided
• Supplement Dates FDA Received: 08/05/2015
• 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
• Patient Outcome(s): Other