BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRIVE MEDICAL

    MDR report key: 3342009 · Received August 13, 2013

    Report

    Report Number
    3342009
    Event Type
    Injury
    Date Received
    August 13, 2013
    Date of Event
    August 8, 2013
    Report Date
    August 9, 2013
    Manufacturer
    MEDICAL DEPOT INC., DBA DRIVE MEDICAL DESIGN AND MANUFACTURING
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    A RESIDENT WAS WHEELING HERSELF INDEPENDENTLY IN HER WHEELCHAIR, WHEN THE LEFT FRONT WHEEL CAME OFF AND CAUSED HER TO FALL. SHE SUSTAINED A 1.5CM LACERATION TO HER LEFT TEMPLE AND WAS EVALUATED FOR FURTHER INJURY AT THE HOSPITAL EMERGENCY ROOM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    388778 DRIVE MEDICAL HEMI WHEELCHAIR, 18" IOR MEDICAL DEPOT INC., DBA DRIVE MEDICAL DESIGN AND MANUFACTURING SSP218DDA-ELR

    Patients

    Seq Age Sex Outcome Treatment
    1 95 YR Required Intervention