BEUDAMED
    FDA Adverse Event Death Summary report: N

    PRIDE

    MDR report key: 1580446 · Received January 15, 2010

    Report

    Report Number
    2530130-2010-00001
    Event Type
    Death
    Date Received
    January 15, 2010
    Date of Event
    November 21, 2009
    Report Date
    January 13, 2010
    Manufacturer
    PRIDE MOBILITY PRODUCTS CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN. THE REPORTER OF THE EVENT DID NOT ALLEGE THAT THE LIFT CHAIR CAUSED OR CONTRIBUTED TO THE EVENT. A F/U REPORT WILL BE SUBMITTED UPON COMPLETION OF INVESTIGATION.

    Description of Event or Problem · 1

    THE CUSTOMER FELL WHILE GETTING OUT OF THE LIFT CHAIR; HE SUSTAINED A FRACTURED PELVIS, HIT HIS HEAD, AND WAS HOSPITALIZED. THE CUSTOMER PASSED AWAY IN 2009 FROM OTHER CAUSES NOT RELATED TO THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE POWERCHAIR ITI PRIDE MOBILITY PRODUCTS CORP. GL358LKD NA

    Patients

    Seq Age Sex Outcome Treatment
    1 94 YR Death