BEUDAMED
    FDA Adverse Event Other Summary report: N

    INVACARE POWER WHEELCHAIR

    MDR report key: 437560 · Received January 6, 2003

    Report

    Report Number
    1525712-2003-00003
    Event Type
    Other
    Date Received
    January 6, 2003
    Date of Event
    November 16, 2002
    Report Date
    January 3, 2003
    Manufacturer
    INVACARE CORPORATION - MANUFACTURING FACILITY
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    NO INFORMATION

    Narratives

    Description of Event or Problem · 1

    THE CONSUMER WAS CROSSING THE STREET WHEN THE LEFT FRONT CASTER FELL OFF, CAUSING THEM TO TUMBLE OUT OF THE CHAIR AND THE CHAIR ON TOP OF THEM. PT ALLEGEDLY BROKE THEIR STERNUM AS A RESULT OF THE ALLEGED INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INVACARE POWER WHEELCHAIR 890.3860 ITI INVACARE CORPORATION - MANUFACTURING FACILITY 2GSTAR-TS NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Hospitalization