FDA Adverse Event
Other
Summary report: N
BCW POWERCHAIR
MDR report key: 545239
·
Received August 12, 2004
Report
- Report Number
- 46787-2004-00001
- Event Type
- Other
- Date Received
- August 12, 2004
- Date of Event
- August 6, 2004
- Report Date
- August 11, 2004
- Manufacturer
- WHEELCHAIRS OF KANSAS
- Product Code
- ITI
- Report Source
- Manufacturer report
- Reporter Occupation
- OTHER
Narratives
Description of Event or Problem · 1
END USER CLAIMS THE REAR LEFT WHEEL BROKE AND USER WAS EJECTED FROM CHAIR. STATES THAT THE END USER HAS BROKEN RIGHT ANKLE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | BCW POWERCHAIR | ELECTRIC WHEELCHAIR | ITI | WHEELCHAIRS OF KANSAS | BCW POWERCHAIR | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNKNOWN | Required Intervention |