BEUDAMED
    FDA Adverse Event Death Summary report: N

    HOVEROUND MPV-4

    MDR report key: 549075 · Received October 15, 2004

    Report

    Report Number
    1056601-2004-00001
    Event Type
    Death
    Date Received
    October 15, 2004
    Date of Event
    September 3, 2004
    Report Date
    October 13, 2004
    Manufacturer
    HOVEROUND CORP.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CONSUMER'S FAMILY MEMBER REPORTED THAT THE CLIENT ALLEGEDLY DROVE THEIR POWER WHEELCHAIR OFF OF DECK. IT IS ALLEGED THAT THIS INCIDENT MAY HAVE CONTRIBUTED TO THEIR DEATH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOVEROUND MPV-4 MOTORIZED WHEELCHAIR ITI HOVEROUND CORP. MPV-4 *

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Death