BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HOVEROUND CORPORATION

    MDR report key: 3981192 · Received July 23, 2014

    Report

    Report Number
    1056601-2014-00013
    Event Type
    Injury
    Date Received
    July 23, 2014
    Date of Event
    March 20, 2014
    Report Date
    July 22, 2014
    Manufacturer
    HOVEROUND CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    NO MALFUNCTION OF THE POWER WHEELCHAIR SUSPECTED. THE END USER WAS STRUCK BY A MOTOR VEHICLE WHILE CROSSING THE STREET IN THE POWER WHEELCHAIR.

    Description of Event or Problem · 1

    END USER WAS REPORTEDLY CROSSING THE ROADWAY IN A CROSSWALK IN THE POWER WHEELCHAIR WHEN SHE WAS STRUCK AND THEN DRAGGED BY A MOTOR VEHICLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    432241 HOVEROUND CORPORATION MOTORIZED WHEELCHAIR ITI HOVEROUND CORP. HOVEROUND MPV5

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Hospitalization