BEUDAMED
    FDA Adverse Event Other Summary report: N

    PRIDE

    MDR report key: 1790578 · Received August 2, 2010

    Report

    Report Number
    2530130-2010-00042
    Event Type
    Other
    Date Received
    August 2, 2010
    Date of Event
    June 11, 2010
    Report Date
    July 28, 2010
    Manufacturer
    PRIDE MOBILITY PRODUCTS CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

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

    Description of Event or Problem · 1

    IT IS ALLEGED THAT THE CUSTOMER WAS TRANSFERRING WHEN THE SEAT ON HER POWERCHAIR BROKE, RESULTING IN A FALL REQUIRING AN ER VISIT.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Hospitalization