BEUDAMED
    FDA Adverse Event Death Summary report: N

    PRIDE

    MDR report key: 1713293 · Received June 2, 2010

    Report

    Report Number
    2530130-2010-00037
    Event Type
    Death
    Date Received
    June 2, 2010
    Date of Event
    April 2, 2007
    Report Date
    May 26, 2010
    Manufacturer
    PRIDE MOBILITY PRODUCTS CORPORATION
    Product Code
    ITI
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    METHOD: DEVICE IS NOT AVAILABLE FOR EVALUATION. RESULTS: USER WAS SEATED IN THE DEVICE IN A VEHICLE AT THE TIME OF A MOTOR VEHICLE ACCIDENT. CONCLUSIONS: FAILURE TO FOLLOW WARNINGS.

    Description of Event or Problem · 1

    THE DAUGHTER OF THE PATIENT ALLEGES THE WHEELCHAIR BROKE FREE FROM THE BASE DURING A MOTOR VEHICLE ACCIDENT; AND AS A RESULT, THE PATIENT PASSED AWAY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE POWERCHAIR ITI PRIDE MOBILITY PRODUCTS CORPORATION JAZZY 1103 ULTRA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Death