BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ROAD WARRIOR

    MDR report key: 44922 · Received October 22, 1996

    Report

    Report Number
    2025750-1996-00001
    Event Type
    Injury
    Date Received
    October 22, 1996
    Date of Event
    June 10, 1996
    Report Date
    September 24, 1996
    Manufacturer
    REDMAN, INC.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    CUSTOMER WAS DRIVING DOWN HER RAMP WHEN HER CHAIR PULLED TO THE RIGHT. SHE ALLEGES THAT THE FRONT RIGHT WHEEL WENT OFF THE RAMP, CAUSING HER TO FALL OUT, ALLEGEDLY FRACTURING HER RIGHT SHOULDER. SHE STATED THAT THE CUSTOMER WAS USING HER SEATBELT, BUT SHE STATED THAT IS WAS NOT LATCHED PROPERLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ROAD WARRIOR BELT DRIVE POWER CHAIR ITI REDMAN, INC. 107RW NA

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Hospitalization