BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PRIDE MOBILITY PRODUCTS

    MDR report key: 4090261 · Received September 15, 2014

    Report

    Report Number
    2530130-2014-00070
    Event Type
    Injury
    Date Received
    September 15, 2014
    Date of Event
    September 8, 2014
    Report Date
    September 15, 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

    THIS CLAIM IS NOT PRODUT RELATED. REPORTED BASED UPON INJURY. USER ERROR WAS THE CAUSE OF THE EVENT.

    Description of Event or Problem · 1

    CUSTOMER WAS DRIVING TO HER RESTROOM AND DROVE INTO HER TOILET.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    568379 PRIDE MOBILITY PRODUCTS POWERED WHEELCHAIR ITI PRIDE MOBILITY PRODUCTS Q6 EDGE N/A

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Hospitalization