BEUDAMED
    FDA Adverse Event Other Summary report: N

    CHAIRMAN VII

    MDR report key: 387888 · Received April 11, 2002

    Report

    Report Number
    1221084-2002-00004
    Event Type
    Other
    Date Received
    April 11, 2002
    Date of Event
    April 4, 2002
    Report Date
    April 8, 2002
    Manufacturer
    PERMOBIL AB
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    TN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    USER WAS DRIVING INTO THEIR TRANSPORTATION VAN. THE STANDING FEATURE BEGAN TO OPERATE ON ITS OWN AND FELL FORWARD FROM A NEAR-STANDING POSITION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CHAIRMAN VII POWERED WHEELCHAIR ITI PERMOBIL AB CH HVII *

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Other