BEUDAMED
    FDA Adverse Event Other Summary report: N

    QUICKIE

    MDR report key: 517063 · Received March 22, 2004

    Report

    Report Number
    2082643-2004-00001
    Event Type
    Other
    Date Received
    March 22, 2004
    Date of Event
    October 31, 2003
    Report Date
    March 22, 2004
    Manufacturer
    SUNRISE MEDICAL. MPD
    Product Code
    IOR
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AL, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    REPORTER STATES THAT PT RECEIVED CHAIR WITHOUT ANTI-TIPS AND WHILE GOING UP THE DRIVEWAY TO THEIR HOME THE CHAIR FLIPPED OVER BACKWARDS AND PT HIT THEIR HEAD AND INJURED THEIR NECK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKIE WHEELCHAIR, MECHANICAL IOR SUNRISE MEDICAL. MPD QUICKIE REVOLUTION P/N EI2D

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other NI SB 2004.