BEUDAMED
    FDA Adverse Event Other Summary report: N

    BREEZY 510 WHEELCHAIR

    MDR report key: 271394 · Received March 27, 2000

    Report

    Report Number
    1524221-2000-00002
    Event Type
    Other
    Date Received
    March 27, 2000
    Date of Event
    February 1, 2000
    Report Date
    March 24, 2000
    Manufacturer
    SUNRISE MEDICAL, MPD
    Product Code
    IOR
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WY, US
    Reporter Occupation
    SERVICE PERSONNEL

    Narratives

    Description of Event or Problem · 1

    REPORTER CLAIMS THE USER WAS IN THE KITCHEN GETTING SOME TEA WHEN THEY PROPPED THEMSELVES WITH THE LEFT SIDE OF THE BREEZY WHEELCHAIR AND THE WHEEL LOCK DID NOT HOLD, SLID FROM THE LEFT CAUSING THEM TO FALL AND BREAK THEIR HIP. AN AMBULANCE CAME TO PICK THEM UP AND EXPLAINED TO SUPPLIER THAT THE WHEEEL LOCKS WERE IN TACT ON THE CHAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BREEZY 510 WHEELCHAIR WHEELCHAIR, MECHANICAL IOR SUNRISE MEDICAL, MPD NA P/N 901532

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Other| R