BEUDAMED
    FDA Adverse Event Other Summary report: N

    PERMOBIL

    MDR report key: 393877 · Received April 11, 2002

    Report

    Report Number
    1221084-2002-00005
    Event Type
    Other
    Date Received
    April 11, 2002
    Date of Event
    May 30, 2001
    Report Date
    April 10, 2002
    Manufacturer
    PERMOBIL AB
    Product Code
    ITI
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    LA, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    WHEELCHAIR REPORTED TO HAVE "COLLAPSED" DUE TO BROKEN BOLT. POSSIBLY A PART OR SUBPART OF THE BACK OR BACK FRAME. USER SUFFERED AN INJURY OF UNKNOWN EXTENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PERMOBIL POWERED WHEELCHAIR WITH STANDING FEATURE ITI PERMOBIL AB NI *

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Other