BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRIDE MOBILITY PRODUCTS

    MDR report key: 2851032 · Received November 29, 2012

    Report

    Report Number
    2530130-2012-00083
    Event Type
    Injury
    Date Received
    November 29, 2012
    Date of Event
    September 7, 2012
    Report Date
    December 12, 2012
    Manufacturer
    PRIDE MOBILITY PRODUCTS
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NH, US
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE WAS EVALUATED IN THE FIELD AND IS WORKING PROPERLY.

    Additional Manufacturer Narrative · 1

    THE DEVICE IS NOT AVAILABLE FOR EVALUATION BY PRIDE AT THIS TIME. SHOULD THE DEVICE OR FURTHER INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL THEN BE SUBMITTED.

    Description of Event or Problem · 1

    CUSTOMERS SON ALLEGES HIS MOTHER WAS GETTING INTO THE CHAIR AND USED HER FEET TO PUSH HERSELF MORE UPRIGHT. AT THAT POINT, THE CHAIR MADE HER GO FORWARD AND SHE FELL OUT IN FRONT OF THE CHAIR SUSTAINING INJURY.

    Description of Event or Problem · 1

    CUSTOMERS SON ALLEGES HIS MOTHER WAS GETTING INTO THE CHAIR AND USED HER FEET TO PUSH HERSELF MORE UPRIGHT. AT THAT POINT, THE CHAIR MADE HER GO FORWARD AND SHE FELL OUT IN FRONT OF THE CHAIR SUSTAINING INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE MOBILITY PRODUCTS POWERED WHEELCHAIR ITI PRIDE MOBILITY PRODUCTS TSS300

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization