BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BOUNDER

    MDR report key: 484572 · Received September 18, 2003

    Report

    Report Number
    2027797-2003-00002
    Event Type
    Injury
    Date Received
    September 18, 2003
    Date of Event
    September 7, 2003
    Report Date
    September 10, 2003
    Manufacturer
    21ST CENTURY SCIENTIFIC, INC.
    Product Code
    ITI
    Report Source
    Manufacturer report
    Reporter Location
    VT, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    USER WAS DRIVING THE CHAIR OUTSIDE AND BROKE THE FORK SPRING BOLT. USER FELL OUT OF THE CHAIR AND SPRAINED/BROKE THEIR LEG.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BOUNDER POWER WHEELCHAIR ITI 21ST CENTURY SCIENTIFIC, INC. BIG BOUNDER *

    Patients

    Seq Age Sex Outcome Treatment
    1 23 YR