FDA Adverse Event
Malfunction
Summary report: N
9684
MDR report key: 193516
·
Received October 22, 1998
Report
- Report Number
- 2183897-1998-00004
- Event Type
- Malfunction
- Date Received
- October 22, 1998
- Report Date
- October 21, 1998
- Manufacturer
- CROW RIVER INDUSTRIES, INC.
- Product Code
- ING
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- MI, US
- Reporter Occupation
- UNKNOWN
Narratives
Description of Event or Problem · 1
REPORT OF ALLEGED "PT INJURED WHILE USING A CROW RIVER LIFT." PT ALLEGEDLY FELL OFF HIS LIFT, AND SUSTAINED INJURIES TO THE FACE AND SHOULDER. PT ALLEGES THAT THE PLATFORM TILTED DOWN WHICH CAUSED THE WHEELCHAIR AND HIMSELF TO ROLL OFF AND FALL TO THE GROUND. PT DID HAVE X-RAYS AFTER THE ACCIDENT, BUT DID NOT RECEIVE ANY BROKEN BONES. HE HAS NOT BEEN BACK TO THE DR SINCE THE INCIDENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | 9684 | AUTOMATIC VAN LIFT | ING | CROW RIVER INDUSTRIES, INC. | 9684 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNKNOWN | Other |