BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HOVEROUND CORPORATION

    MDR report key: 4173267 · Received September 26, 2014

    Report

    Report Number
    1056601-2014-00016
    Event Type
    Injury
    Date Received
    September 26, 2014
    Date of Event
    November 25, 2013
    Report Date
    September 24, 2014
    Manufacturer
    HOVEROUND CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NE, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    NO MALFUNCTION OF THE POWER WHEELCHAIR SUSPECTED. END USER REPORTED ACCIDENTALLY DROVE POWER WHEELCHAIR DOWN STAIRS. HOVEROUND'S OWNER'S MANUAL WARNS END USERS TO REDUCE THE CHANCE OF SERIOUS INJURY OR DEATH FROM TIP-OVER..."NEVER ATTEMPT TO DRIVE A POWER WHEELCHAIR OFF OR UP ONTO A CURB, STAIRS HIGHER THAN 1.5 INCHES, OR AN ESCALATOR."

    Description of Event or Problem · 1

    END USER'S REPORTS SITTING IN THE POWER WHEELCHAIR OUTSIDE OF HER APARTMENT WHEN SHE ACCIDENTALLY PUSHED THE JOYSTICK IN REVERSE AND DROVE OVER THE EDGE OF THE STAIRCASE, FALLING DOWN 5 STEPS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    600916 HOVEROUND CORPORATION MOTORIZED WHEELCHAIR ITI HOVEROUND CORP. HOVEROUND MPV5

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Hospitalization