BEUDAMED
    FDA Adverse Event Other Summary report: N

    PRIDE

    MDR report key: 498198 · Received November 24, 2003

    Report

    Report Number
    2530130-2003-00022
    Event Type
    Other
    Date Received
    November 24, 2003
    Date of Event
    September 16, 2003
    Report Date
    November 24, 2003
    Manufacturer
    PRIDE MOBILITY PRODUCTS EXETER, PA
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE END USER ALLEGES THEY WERE DRIVING DOWN A SLANTED PATH WHEN THEY DROVE OFF AND FELL DOWN A TEN FOOT EMBANKMENT. THE END USER SUSTAINED A FRACTURED VERTEBRAE/SPINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIDE JAZZY ITI PRIDE MOBILITY PRODUCTS EXETER, PA 1122 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Hospitalization| O