BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PROBASICS

    MDR report key: 17443967 · Received August 2, 2023

    Report

    Report Number
    3012316249-2023-00028
    Event Type
    Injury
    Date Received
    August 2, 2023
    Date of Event
    June 2, 2023
    Report Date
    August 2, 2023
    Manufacturer
    JIANGSU INTCO MEDICAL PRODUCTS CO., LTD.
    Product Code
    IMM
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 0

    PATIENT ATTEMPTED TO AMBULATE AND GOT HER FEET CAUGHT IN THE FOOTREST OF THE WHEELCHAIR FALLING FORWARD RESULTING IN PELVIC FRACTURE REQUIRING SURGICAL INTERVENTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1467468 PROBASICS K2 WHEELCHAIR, 18X16 W/SAFR IMM JIANGSU INTCO MEDICAL PRODUCTS CO., LTD. WC21816DS

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR Female Required Intervention| H