BEUDAMED
    FDA Adverse Event Death Summary report: N

    MEDLINE WHEELCHAIR

    MDR report key: 419880 · Received September 30, 2002

    Report

    Report Number
    MW1026310
    Event Type
    Death
    Date Received
    September 30, 2002
    Date of Event
    September 17, 2002
    Report Date
    September 30, 2002
    Manufacturer
    MEDLINE INDUSTRIES, INC.
    Product Code
    IOR
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    WHEELCHAIR MODEL # MDS808200 WAS FOUND TO BE EXTREMELY UNSTABLE. PT FELL OVER BACKWARD, STRUCK BACK OF HEAD AND DIED. CO WAS NOTIFIED BY PURCHASING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDLINE WHEELCHAIR WHEELCHAIR IOR MEDLINE INDUSTRIES, INC. MDS808200 *

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Death