BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRIDE MOBILITY PRODUCTS

    MDR report key: 2873873 · Received December 14, 2012

    Report

    Report Number
    2530130-2012-00086
    Event Type
    Injury
    Date Received
    December 14, 2012
    Date of Event
    May 10, 2011
    Report Date
    May 28, 2013
    Manufacturer
    PRIDE MOBILITY PRODUCTS
    Product Code
    IOR
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Additional Manufacturer Narrative · 1

    THE MODEL NUMBER, SERIAL NUMBER, MANUFACTURE DATE, AND THE DEVICE ITSELF ARE NOT AVAILABLE AT THIS TIME. SHOULD THE DEVICE OR FURTHER INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL THEN BE SUBMITTED.

    Additional Manufacturer Narrative · 1

    THE COMMON DEVICE NAME, MODEL NUMBER, SERIAL NUMBER, AND MANUFACTURE DATE HAVE BEEN UPDATED. THE DEVICE IS NOT AVAILABLE FOR EVALUATION AT THIS TIME. SHOULD THE DEVICE OR FURTHER INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL THEN BE SUBMITTED.

    Additional Manufacturer Narrative · 1

    REPRESENTATIVE FROM PRIDE REVIEWED PRODUCT AND CONFIRMED IT WAS A PRIDE CHAIR. THE UNIT WAS ABUSED AND BROKE ON ONE SIDE WITH A STRANGE SUBSTANCE ON BROKEN CLAMP.

    Description of Event or Problem · 1

    CLAIMANT RENTED UNIT FROM (B)(6) IN (B)(6). IN (B)(6), WHILE AT HOSPITAL, THE WHEELCHAIR STRUCK CONCRETE CAUSING PLANTIFF TO BOUNCE FORWARD AND CLAIMS SEAT BELT BROKE CAUSING HIM TO FALL OUT.

    Description of Event or Problem · 1

    CLAIMANT RENTED UNIT FROM DW AUTO IN (B)(6). IN MAY, WHILE AT HOSPITAL, THE WHEELCHAIR STRUCK CONCRETE CAUSING PLANTIFF TO BOUNCE FORWARD AND CLAIMS SEAT BELT BROKE CAUSING HIM TO FALL OUT.

    Description of Event or Problem · 1

    CLAIMANT RENTED UNIT FROM DW AUTO IN (B)(6). IN (B)(6), WHILE AT HOSPITAL, THE WHEELCHAIR STRUCK CONCRETE CAUSING PLANTIFF TO BOUNCE FORWARD AND CLAIMS SEAT BELT BROKE CAUSING HIM TO FALL OUT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE MOBILITY PRODUCTS MECHANICAL WHEELCHAIR IOR PRIDE MOBILITY PRODUCTS STYLUS LS

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization