BEUDAMED
    FDA Adverse Event Other Summary report: N

    PRIDE

    MDR report key: 227002 · Received June 8, 1999

    Report

    Report Number
    2530130-1999-00015
    Event Type
    Other
    Date Received
    June 8, 1999
    Date of Event
    April 27, 1999
    Report Date
    June 3, 1999
    Manufacturer
    PRIDE MOBILITY PRODUCTS CORP.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    END USER WAS TRAVELING UP AN INCLINE ON A HANDICAPPED PATH AT AREA PARK. END USER CLAIMS THE SCOOTER SURGED FORWARD CAUSING THE FRONT WHEELS TO GO UP CAUSING THE SCOOTER TO FLIP BACKWARDS LANDING ON TOP OF HIM. END USER ALLEGES PELVIS/HIP/TAILBONE INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE SCOOTER INI PRIDE MOBILITY PRODUCTS CORP. SC340 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Hospitalization