BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HOVEROUND CORPORATION

    MDR report key: 1233862 · Received November 13, 2008

    Report

    Report Number
    1056601-2008-00024
    Event Type
    Injury
    Date Received
    November 13, 2008
    Date of Event
    June 13, 2008
    Report Date
    October 27, 2008
    Manufacturer
    HOVEROUND CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    NO MALFUNCTION OF MOTORIZED WHEELCHAIR SUSPECTED. ACCORDING TO THE POLICE REPORT, THE MOTOR VEHICLE WAS OPERATING RECKLESSLY AND STRUCK THE END USER WHO WAS OPERATING THE MOTORIZED WHEELCHAIR.

    Description of Event or Problem · 1

    ALLEGEDLY, THE END USER WAS STRUCK BY A MOTOR VEHICLE WHILE OPERATING THE MOTORIZED WHEELCHAIR IN THE ROADWAY. AS A RESULT OF THE ALLEGED INCIDENT, THE END USER RECEIVED MULTIPLE INJURIES AND REQUIRED HOSPITALIZATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOVEROUND CORPORATION MOTORIZED WHEELCHAIR ITI HOVEROUND CORP. MPV5

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Hospitalization