BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE MEDICAL

    MDR report key: 2926229 · Received January 17, 2013

    Report

    Report Number
    2438477-2013-00004
    Event Type
    Injury
    Date Received
    January 17, 2013
    Date of Event
    June 9, 2012
    Report Date
    November 16, 2012
    Manufacturer
    UNKNOWN
    Product Code
    INM
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    MN, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    (B)(4) HAS RECEIVED AN ATTORNEY LETTER AND A NOTICE OF POSSIBLE CLAIM FROM A LAW FIRM ABOUT AN INCIDENT INVOLVING A SHOWER CHAIR ALLEGEDLY IMPORTED AND DISTRIBUTED BY (B)(4). THE ATTORNEY STATED THAT THE CLAIMANT WAS A GUEST AT A HOTEL IN (B)(6). WHEN HE ATTEMPTED TO USE THE SHOWER CHAIR PROVIDE BY THE HOTEL, THE CHAIR COLLAPSED CAUSING HIM TO FALL AND SUSTAIN SERIOUS INJURIES. DRIVE MEDICAL HAD REACHED OUT TO THE ATTORNEY OFFICE INVESTIGATE THE INCIDENT. ALLEGEDLY THE CLAIMANT RECEIVED A COMPRESSION FRACTURE ON HIS TAILBONE WITH BRUISES AND BUMPS. THIS MDR REPORT IS BASED ON THE INFORMATION PROVIDED BY CLAIMANT'S ATTORNEY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    26164 DRIVE MEDICAL SHOWER CHAIR INM UNKNOWN UNKNOWN NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention