BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HOVEROUND CORPORATION

    MDR report key: 1882494 · Received October 20, 2010

    Report

    Report Number
    1056601-2010-00025
    Event Type
    Injury
    Date Received
    October 20, 2010
    Date of Event
    September 20, 2010
    Report Date
    October 18, 2010
    Manufacturer
    HOVEROUND CORPORATION
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    RI, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    NO MALFUNCTION OF MOTORIZED WHEELCHAIR SUSPECTED. ACCORDING TO THE END USER, THE BUS DRIVER DID NOT PROPERLY LOWER THE BUS AND THE RAMP WAS TOO STEEP. THE MOTORIZED WHEELCHAIR PERFORMED AS INTENDED DURING EVALUATION IN THE FIELD. END USER REPORTED THAT HE WAS NOT WEARING THE SEAT BELT. THE OWNER'S MANUAL WARNS, "ALWAYS USE THE SEAT BELT".

    Description of Event or Problem · 1

    END USER ALLEGES WHILE EXITING A PUBLIC TRANSPORT BUS HE FELL OUT OF THE MOTORIZED WHEELCHAIR MIDWAY DOWN THE EXIT RAMP. ALLEGEDLY, AS A RESULT OF THE INCIDENT THE END USER WAS HOSPITALIZED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOVEROUND CORPORATION MOTORIZED WHEELCHAIR ITI HOVEROUND CORPORATION XHD

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Hospitalization