BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRIDE MOBILITY PRODUCTS

    MDR report key: 3922804 · Received July 9, 2014

    Report

    Report Number
    2530130-2014-00052
    Event Type
    Injury
    Date Received
    July 9, 2014
    Date of Event
    June 25, 2014
    Report Date
    September 5, 2014
    Manufacturer
    PRIDE MOBILITY PRODUCTS
    Product Code
    ITI
    PMA / PMN Number
    K042612
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE HAS NOT BEEN MADE AVAILABLE FOR EVALUATION AT THIS TIME. SHOULD FURTHER INFORMATION OR THE DEVICE BECOME AVAILABLE, A FOLLOW-UP REPORT WILL THEN BE ISSUED.

    Additional Manufacturer Narrative · 1

    FAILURE TO FOLLOW JOYSTICK BUSS CABLE ROUTING INSTRUCTIONS.

    Description of Event or Problem · 1

    DEALER REPORTED CUSTOMER IS RUNNING OVER HER CHARGER CORD CAUSING IT TO FRAY. SHE REPORTED SHE WAS HURT.

    Description of Event or Problem · 1

    DEALER REPORTED CUSTOMER IS RUNNING OVER HER CHARGER CORD CAUSING IT TO FRAY. SHE REPORTED SHE WAS HURT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    399642 PRIDE MOBILITY PRODUCTS POWERED WHEELCHAIR ITI PRIDE MOBILITY PRODUCTS J614HD N/A

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization