BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRIDE MOBILITY PRODUCTS

    MDR report key: 2938163 · Received January 31, 2013

    Report

    Report Number
    2530130-2013-00008
    Event Type
    Injury
    Date Received
    January 31, 2013
    Date of Event
    January 3, 2013
    Report Date
    January 31, 2013
    Manufacturer
    PRIDE MOBILITY PRODUCTS
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    SERVICE PERSONNEL

    Narratives

    Additional Manufacturer Narrative · 1

    CONSUMER STATED THAT THE SEAT WAS ADJUSTED IMPROPERLY DURING HER LAST REPAIR FROM (B)(4) (A DIVIISON OF INVACARE CORPORATION). THE SEAT WAS ADJUSTED TOO HIGH AND THEREFORE THE CONSUMER WAS NOT ABLE TO TRANSFER PROPERLY WHICH CAUSED THE FALL. A PRIDE REPRESENTATIVE VISITED CONSUMER, REPLACED BATTERIES, AND DID AN OVERALL CHECK OF THE DEVICE. THE DEVICE IS WORKING PROPERLY.

    Description of Event or Problem · 1

    CUSTOMER ALLEGES THAT SHE WENT TO SIT IN THE CHAIR AND FELL AND BROKE HER LEG FROM THE FALL. CONSUMER WENT TO THE HOSPITAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    42675 PRIDE MOBILITY PRODUCTS POWERED WHEELCHAIR ITI PRIDE MOBILITY PRODUCTS JAZZY 600XL

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization