BEUDAMED
    FDA Adverse Event Death Summary report: N

    RASCAL

    MDR report key: 277003 · Received May 11, 2000

    Report

    Report Number
    2246975-2000-00001
    Event Type
    Death
    Date Received
    May 11, 2000
    Date of Event
    April 7, 2000
    Report Date
    April 12, 2000
    Manufacturer
    ELECTRIC MOBILITY CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    WITNESS'S STATEMENT ON THE POLICE REPORT: "I WAS MAKING A RIGHT TURN FROM ONE STREET ONTO THE OTHER. A WHITE MAZDA WITH A DRIVER WENT BY ME GOING FAST. I FINISHED MY TURN AND I WAS GOING UP THE STREET WHEN I SAW THE WHEELCHAIR COMING DOWN THE HILL. AT THIS TIME I SAW THE WHEELCHAIR ROCKING FROM SIDE TO SIDE. I KNEW IT WAS GOING TO TIP OVER SO I STOPPED. AS THE WHEELCHAIR WENT BY US IT FLIPPED AND THE DRIVER WAS THROWN OFF. I GOT OUT OF MY TRUCK AND CALLED THE FIRE DEPT." OPR #1 WAS PRONOUNCED DEAD AT SCENE AT 1557 HRS BY PARAMEDIC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RASCAL VEHICLE, MOTORIZED 3-WHEELER ITI ELECTRIC MOBILITY CORP. 245 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Death