BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AMIGO

    MDR report key: 467881 · Received June 24, 2003

    Report

    Report Number
    1821729-2003-00001
    Event Type
    Injury
    Date Received
    June 24, 2003
    Date of Event
    July 30, 1999
    Report Date
    July 16, 2001
    Manufacturer
    AMIGO MOBILITY INT'L INC.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    USER INJURED LEFT HIP, LEG AND KNEE WHEN THROWN FROM THE SCOOTER. THE THROTTLE ON THE SCOOTER WAS STUCK CAUSING PT TO FALL FROM A VAN/LIFT ONTO THE CEMENT FLOOR OF THE GARAGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AMIGO MOTORIZED SCOOTER INI AMIGO MOBILITY INT'L INC. 350000V *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other