FDA Adverse Event
Summary report: N
POWERED WHEELCHAIR
MDR report key: 3771652
·
Received April 24, 2014
Report
- Report Number
- 3004493922-2014-00568
- Date Received
- April 24, 2014
- Report Date
- March 24, 2014
- Manufacturer
- INVACARE SUZHOU
- Product Code
- ITI
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AL, US
- Reporter Occupation
- PATIENT
Narratives
Description of Event or Problem · 1
END USER STATED THAT SHE WAS ATTEMPTING TO GET OFF THE TOILET ONTO THE POWER CHAIR WHEN SHE GRABBED ONTO THE KNOB OF THE JOYSTICK WHEN THE POWER CHAIR MOVED FORWARD KNOCKING HER DOWN. END USER STATED THAT SHE FELL ONTO THE FLOOR ON HER BUTTOCKS AND THE POWER PROCEEDED WITH RUNNING HER RIGHT FOOT OVER. END USER STATED THAT HER NEPHEW WAS ABLE TO GET HER UP. END USER STATED HER RIGHT FOOT IS STILL SORE AND SHE PLANS ON SEEKING MEDICAL INTERVENTION.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 250305 | POWERED WHEELCHAIR | 890.3860 | ITI | INVACARE SUZHOU | M41SRR |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 92 | Other |