BEUDAMED
    FDA Adverse Event Other Summary report: N

    WHEELCHAIR, ALUM. TRANSPORT, 12"

    MDR report key: 1943029 · Received December 22, 2010

    Report

    Report Number
    1417592-2010-00074
    Event Type
    Other
    Date Received
    December 22, 2010
    Date of Event
    December 1, 2010
    Report Date
    December 10, 2010
    Manufacturer
    MEDLINE INDUSTRIES, INC.
    Product Code
    IOR
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE END USER WAS BEING PUSHED OVER A CURB WHEN THE HANDLES OF THE TRANSPORT CHAIR BROKE AND SHE FELL BACKWARD, HITTING HER HEAD. SHE WAS EVALUATED BY HER PHYSICIAN. NO SERIOUS INJURY WAS REPORTED. WE ARE WAITING FOR THE SAMPLE TO IDENTIFY A ROOT CAUSE AND DETERMINE IF ANY CORRECTIVE ACTIONS NEED TO BE TAKEN. DUE TO THE REPORTED INCIDENT, THIS MEDWATCH IS BEING FILED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE HANDLES OF THE CHAIR BROKE AS THE END USER WAS BEING PUSHED OVER A CURB. SHE FELL, HITTING HER HEAD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 WHEELCHAIR, ALUM. TRANSPORT, 12" NONE IOR MEDLINE INDUSTRIES, INC. MDS808210AR NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Other