BEUDAMED
    FDA Adverse Event Death Summary report: N

    QUICKIE

    MDR report key: 418914 · Received September 27, 2002

    Report

    Report Number
    2082643-2002-00209
    Event Type
    Death
    Date Received
    September 27, 2002
    Date of Event
    August 1, 2002
    Report Date
    September 27, 2002
    Manufacturer
    SUNRISE MEDICAL, MPD
    Product Code
    ITI
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    REPORTER STATED THAT THE END-USER FELL OUT OF CHAIR HITTING THEIR HEAD. END-USER SUBSEQUENTLY HAD SURGERY AND DIED 1 MONTH AND 12 DAYS LATER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKIE WHEELCHAIR, POWERED ITI SUNRISE MEDICAL, MPD QUICKIE S525 P/N CIS52

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Death