BEUDAMED
    FDA Adverse Event Death Summary report: N

    HOVEROUND CORPORATION

    MDR report key: 3093845 · Received April 26, 2013

    Report

    Report Number
    1056601-2013-00010
    Event Type
    Death
    Date Received
    April 26, 2013
    Date of Event
    April 8, 2013
    Report Date
    April 4, 2013
    Manufacturer
    HOVEROUND CORP.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    OPERATOR ERROR: NO MALFUNCTION OF THE POWER WHEELCHAIR SUSPECTED. THE END USER WAS STRUCK BY A TRUCK WHILE SITTING IN THE POWER WHEELCHAIR. HOVEROUND OWNER'S MANUAL WARNS END USERS "TO AVOID SERIOUS INJURY OR DEATH FROM BEING STRUCK BY A MOTOR VEHICLE, WHEN DRIVING YOUR POWER WHEELCHAIR NEAR TRAFFIC, CROSS ROADS AT LOCATIONS WHERE YOU ARE MOST VISIBLE TO MOTOR TRAFFIC."

    Description of Event or Problem · 1

    (B)(6) REPORTS END USER WAS SITTING IN POWER WHEELCHAIR AT A STREET CORNER AND WAS STRUCK BY A TRUCK MAKING A RIGHT-HAND TURN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    181607 HOVEROUND CORPORATION MOTORIZED WHEELCHAIR INI HOVEROUND CORP. FWD

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR Death