BEUDAMED
    FDA Adverse Event Injury Summary report: N

    QUICKIE

    MDR report key: 1051846 · Received May 23, 2008

    Report

    Report Number
    2937137-2008-00006
    Event Type
    Injury
    Date Received
    May 23, 2008
    Date of Event
    April 24, 2008
    Report Date
    May 23, 2008
    Manufacturer
    SUNRISE MEDICAL
    Product Code
    IOR
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    DE, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THERE HAVE BEEN NO PARTS OR THE CHAIR RETURNED BACK TO THE MFR FOR EVAL AS OF THIS DATE.

    Description of Event or Problem · 1

    THE RPTR STATED THAT THE END-USER WAS GOING DOWN A SLIGHT HILL AND THERE WAS A CRACK ON THE SIDEWALK, THE END-USER RAN INTO THE CRACK AND THE CHAIR FLIPPED FORWARD WITH THE END-USER IN THE CHAIR. THE REPORTER STATED THAT THE END-USER REC'D FRACTURES IN THE RIGHT ARM, RIGHT LEG AND HIP. THERE WAS NO MENTION OF THE END-USER RECEIVING MEDICAL ATTN IN THIS REPORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKIE WHEELCHAIR, MECHANICAL IOR SUNRISE MEDICAL QUICKIE GT P/N EIR3

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Other