BEUDAMED
    FDA Adverse Event Other Summary report: N

    PRIDE

    MDR report key: 1631491 · Received March 12, 2010

    Report

    Report Number
    2530130-2010-00020
    Event Type
    Other
    Date Received
    March 12, 2010
    Date of Event
    March 1, 2010
    Report Date
    March 8, 2010
    Manufacturer
    PRIDE MOBILITY PRODUCTS CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    NOT A PRODUCT PROBLEM, MDR REPORTED DUE TO INJURY; USER ERROR.

    Description of Event or Problem · 1

    THE END USER WAS REACHING FOR HER GLASSES AND SHE ALLEGES THAT THE CHAIR MOVED FORWARD CAUSING HER TO FALL OUT. THE USER HIT HER HEAD AND WAS TAKEN TO THE ER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE POWERCHAIR ITI PRIDE MOBILITY PRODUCTS CORP. Q600 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Required Intervention