BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RASCAL

    MDR report key: 507384 · Received January 21, 2004

    Report

    Report Number
    2246975-2003-00115
    Event Type
    Injury
    Date Received
    January 21, 2004
    Date of Event
    December 4, 2003
    Report Date
    December 26, 2003
    Manufacturer
    ELECTRIC MOBILITY CORP.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NE, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CUSTOMER GRABBED HANDLE BAR TO AID THEM WHILE BENDING OVER & STRUCK THE ENGAGER. UNIT MOVED & KNOCKED THEM OVER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RASCAL VEHICLE, 3-WHEEL MOTORIZED INI ELECTRIC MOBILITY CORP. 245 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 95 YR Hospitalization