BEUDAMED
    FDA Adverse Event Other Summary report: N

    PERMOBIL M300

    MDR report key: 3170012 · Received June 10, 2013

    Report

    Report Number
    MW5030525
    Event Type
    Other
    Date Received
    June 10, 2013
    Date of Event
    June 7, 2013
    Report Date
    June 10, 2013
    Manufacturer
    PERMOBIL, INC
    Product Code
    ITI
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PERMOBIL M300. SERIAL #: (B)(4). PT WAS EATING DINNER AND THE WHEELCHAIR'S JOYSTICK MAY HAVE GOTTEN STUCK UNDER THE TABLE, MOST LIKELY WHEN PT WAS POSITIONED OR DROVE UP TO THE TABLE. PT ACCIDENTLY HIT THE ON/OFF SWITCH WITH CHEEK WHILE SHE WAS EATING AND THIS COMBINATION CAUSED THE WHEELCHAIR TO TURN ON AND ACCELERATED, CAUSING HER TO PLOW THROUGH SEVERAL TABLES. THE PT DID NOT SUSTAIN INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    261443 PERMOBIL M300 POWER WHEEL CHAIR ITI PERMOBIL, INC M300 0000566

    Patients

    Seq Age Sex Outcome Treatment
    1 33 YR