FDA Adverse Event
Death
Summary report: N
PRIDE MOBILITY PRODUCTS
MDR report key: 2873856
·
Received December 14, 2012
Report
- Report Number
- 2530130-2012-00088
- Event Type
- Death
- Date Received
- December 14, 2012
- Date of Event
- November 20, 2012
- Report Date
- December 12, 2012
- Manufacturer
- PRIDE MOBILITY PRODUCTS
- Product Code
- ITI
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Occupation
- PATIENT FAMILY MEMBER OR FRIEND
Narratives
Additional Manufacturer Narrative · 1
THE FIRE MARSHAL REPORT DETERMINED THE FIRE TO BE ACCIDENTAL. CARELESS SMOKING MAY HAVE CONTRIBUTED TO THIS INCIDENT. SHOULD FURTHER INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL BE SUBMITTED. DEVICE WAS DISPOSED OF.
Description of Event or Problem · 1
REPORT OF A FIRE THAT OCCURRED IN A HOME WHERE A POWERCHAIR WAS PRESENT. FATALITY REPORTED. NO WITNESSES PRESENT WHEN THE FIRE STARTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | PRIDE MOBILITY PRODUCTS | POWERED WHEELCHAIR | ITI | PRIDE MOBILITY PRODUCTS | JAZZY SELECT |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Death |