BEUDAMED
    FDA Adverse Event Other Summary report: N

    PRIDE

    MDR report key: 1673953 · Received April 30, 2010

    Report

    Report Number
    2530130-2010-00033
    Event Type
    Other
    Date Received
    April 30, 2010
    Date of Event
    April 8, 2010
    Report Date
    April 26, 2010
    Manufacturer
    PRIDE MOBILITY PRODUCTS CORP.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, 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

    THE CUSTOMER ALLEGES THE SCOOTER LURCHED FORWARD PINNING HIS LEG AGAINST A CHURCH PEW; THE INJURY REQUIRED HOSPITALIZATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE SCOOTER INI PRIDE MOBILITY PRODUCTS CORP. SC40E NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Hospitalization