BEUDAMED
    FDA Adverse Event Other Summary report: N

    QUICKIE

    MDR report key: 1062840 · Received June 17, 2008

    Report

    Report Number
    2937137-2008-00007
    Event Type
    Other
    Date Received
    June 17, 2008
    Date of Event
    May 19, 2008
    Report Date
    June 17, 2008
    Manufacturer
    SUNRISE MEDICAL, INC.
    Product Code
    IOR
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    AS OF THIS DATE, THIS ITEM HAS NOT BEEN RETURNED TO THE MANUFACTURE FOR EVAL.

    Description of Event or Problem · 1

    THE REPORTER STATED THAT THE END-USER WAS WITH SOME FRIENDS, A FRIEND WAS PUSHING THE END-USER DOWN, AND INCLINE AT A FAST SPEED WHEN THE CHAIR RAN INTO A CRACK IN THE SIDEWALK, CAUSING THE CHAIR TO COME TO A QUICK STOP, THE END-USER'S FRIEND THAT WAS PUSHING THE END-USER, HIS MOMENTUM PUSHED THE CHAIR FORWARD CAUSING THE END-USER TO FALL. THERE WERE NO INJURIES TO THE END USER AS INITIALLY REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKIE WHEELCHAIR, MECHANICAL IOR SUNRISE MEDICAL, INC. QUICKIE TITANIUM P/N EIT3

    Patients

    Seq Age Sex Outcome Treatment
    1 Other