BEUDAMED
    FDA Adverse Event Death Summary report: N

    HOVEROUND CORPORATION

    MDR report key: 1577014 · Received January 8, 2010

    Report

    Report Number
    1056601-2010-00001
    Event Type
    Death
    Date Received
    January 8, 2010
    Date of Event
    December 15, 2009
    Report Date
    January 7, 2010
    Manufacturer
    HOVEROUND CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THE MOTORIZED WHEELCHAIR WAS NOT RETURNED TO HOVEROUND; HOWEVER, NO MALFUNCTION SUSPECTED. REPORTER REPORTED THE END USER WAS STRUCK BY A MOTOR, VEHICLE WHILE CROSSING A HIGHWAY IN A MOTORIZED WHEELCHAIR.

    Description of Event or Problem · 1

    REPORTER REPORTED END USER WAS STRUCK BY A MOTOR VEHICLE WHILE CROSSING A HIGHWAY IN THE MOTORIZED WHEELCHAIR.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Death