BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AMIGO

    MDR report key: 467885 · Received June 24, 2003

    Report

    Report Number
    1821729-2003-00004
    Event Type
    Injury
    Date Received
    June 24, 2003
    Date of Event
    July 17, 2002
    Report Date
    July 17, 2002
    Manufacturer
    AMIGO MOBILITY INT'L INC.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    USER SUFFERED A HEAD INJURY WHEN PT FELL OUT OF THE SCOOTER AFTER THE EMERGENCY BRAKE FAILED AND THE SCOOTER ROLLED BACK DOWN A HILL AND TRIPPED OVER.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other