BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRIDE MOBILITY PRODUCTS

    MDR report key: 2873848 · Received December 14, 2012

    Report

    Report Number
    2530130-2012-00090
    Event Type
    Injury
    Date Received
    December 14, 2012
    Date of Event
    August 25, 2012
    Report Date
    December 12, 2012
    Manufacturer
    PRIDE MOBILITY PRODUCTS
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE SERIAL NUMBER, DEVICE MANUFACTURE DATE, OR CONSUMER INFORMATION HAVE NOT BEEN PROVIDED. SHOULD THE DEVICE OR FURTHER INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL THEN BE SUBMITTED.

    Description of Event or Problem · 1

    RECEIVED A VOLUNTARY REPORT (B)(4) FROM FDA'S MEDWATCH PRGROAM ALLEGING THAT THE THREE-WHEELED CART TIPPED COMPLETELY OVER CAUSING INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE MOBILITY PRODUCTS MOTORIZED THREE-WHEELED VEHICLE INI PRIDE MOBILITY PRODUCTS GO GO 3 WHEEL

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization