BEUDAMED
    FDA Adverse Event Other Summary report: N

    QUICKIE

    MDR report key: 1033073 · Received April 24, 2008

    Report

    Report Number
    2937137-2008-00004
    Event Type
    Other
    Date Received
    April 24, 2008
    Date of Event
    March 16, 2008
    Report Date
    April 17, 2008
    Manufacturer
    SUNRISE MEDICAL, INC.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    AS OF THIS DATE, THIS CHAIR HAS NOT BEEN RETURNED TO THE MFR FOR AN EVALUATION.

    Description of Event or Problem · 1

    THE REPORTER STATED THAT THE END-USER WAS TRANSFERRING INTO HIS CHAIR FROM A LIFT CHAIR, WHEN THE END-USER STARTED TO REACH FOR THE ARMREST, THE ARMREST CAME OFF AND THE END-USER FELL TO THE GROUND.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKIE WHEELCHAIR, POWERED ITI SUNRISE MEDICAL, INC. QUICKIE FREESTYLE P/N EIPW9

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Hospitalization