BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RASCAL

    MDR report key: 507073 · Received January 16, 2004

    Report

    Report Number
    2246975-2003-00114
    Event Type
    Injury
    Date Received
    January 16, 2004
    Date of Event
    November 26, 2003
    Report Date
    December 17, 2003
    Manufacturer
    ELECTRIC MOBILITY CORP.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CUSTOMER CLAIMS UNIT TIPPED OVER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RASCAL VEHICLE, 3-WHEEL MOTORIZED INI ELECTRIC MOBILITY CORP. 235 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Hospitalization| R