BEUDAMED
    FDA Adverse Event Other Summary report: N

    INDEPENDENCE IBOT MOBILITY SYSTEM

    MDR report key: 554767 · Received April 29, 2004

    Report

    Report Number
    3003508375-2004-00001
    Event Type
    Other
    Date Received
    April 29, 2004
    Date of Event
    March 29, 2004
    Report Date
    April 29, 2004
    Manufacturer
    INDEPENDENCE TECHNOLOGY, L.L.C.
    Product Code
    IMK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CONSUMER FELL COMING OUT OF THE PUB TOILET IN BALANCE FUNCTION AS WHEELS GOT STUCK IN THE PARTITION CAUSING THE FALL. THIS IS THE THIRD TIME IN FOUR MONTHS THIS CONSUMER HAS FALLEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INDEPENDENCE IBOT MOBILITY SYSTEM STAIR CLIMBING WHEELCHAIR IMK INDEPENDENCE TECHNOLOGY, L.L.C. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other