BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RASCAL

    MDR report key: 1701628 · Received May 19, 2010

    Report

    Report Number
    2246975-2010-00001
    Event Type
    Injury
    Date Received
    May 19, 2010
    Date of Event
    April 28, 2010
    Report Date
    May 13, 2010
    Manufacturer
    ELECTRIC MOBILITY CORP.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    CUSTOMER RODE SCOOTER THROUGH A WASHED OUT GULLY IN BACKYARD. BROKE LEG IN 5 PLACES AND HAD A STEEL ROD INSERTED. REQUIRED HOSP STAY FOR INJURIES. USER ERROR - NO MALFUNCTION OF UNIT. INSTRUCTED CUSTOMER ON PROPER USE OF UNIT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RASCAL VEHICLE, 3 WHEELED, MOTORIZED INI ELECTRIC MOBILITY CORP. 300

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Hospitalization