BEUDAMED
    FDA Adverse Event Death Summary report: N

    PRIDE

    MDR report key: 1654042 · Received April 6, 2010

    Report

    Report Number
    2530130-2010-00029
    Event Type
    Death
    Date Received
    April 6, 2010
    Date of Event
    March 18, 2010
    Report Date
    April 5, 2010
    Manufacturer
    PRIDE MOBILITY PRODUCTS CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE EVAL ANTICIPATED, BUT NOT YET BEGUN. A FOLLOW UP REPORT WILL BE SUBMITTED UPON COMPLETION OF INVESTIGATION.

    Description of Event or Problem · 1

    RECEIVED A CALL FROM A FIRE MARSHALL ALLEGING, A FIRE OCCURRED IN AN APARTMENT COMPLEX WHERE A PRIDE POWERCHAIR WAS LOCATED. THE USER PASSED AWAY FROM INJURIES SUSTAINED FROM THE FIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE POWERCHAIR ITI PRIDE MOBILITY PRODUCTS CORP. JET 3 ULTRA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Death