BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POWER WHEELCHAIR

    MDR report key: 6069082 · Received October 29, 2016

    Report

    Report Number
    MW5065726
    Event Type
    Injury
    Date Received
    October 29, 2016
    Date of Event
    October 28, 2016
    Report Date
    October 29, 2016
    Manufacturer
    PERMOBIL, INC.
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    I GOT OFF THE BUS AND AS I WAS GOING DOWN MY DRIVEWAY, MY RIGHT MOTOR JUST LET GO AND MY WHOLE WHEELCHAIR SPUN COUNTERCLOCKWISE VERY QUICKLY. THIS COULD HAVE LIFE THREATENING. THE RIGHT MOTOR IS NOW INOPERABLE. THERE ARE NO MOTOR ERROR CODES ON THE JOYSTICK. I HAVE THE 7.5 MPH MOTORS. I WILL BE ORDERING A NEW PERMOBIL IN FEBRUARY AND IF I WERE TO ORDER A NEW MOTOR MY INSURANCE COMPANY WILL DENY MY NEW CHAIR. I WOULD LIKE NEW 7.5 MPH MOTOR INCLUDING LABOR AT NO CHARGE, IF YOU CANNOT DO THAT THEN I WOULD LIKE A LOANER CHAIR UNTIL I GET MY NEW CHAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    716701 POWER WHEELCHAIR WHEELCHAIR ITI PERMOBIL, INC. M300

    Patients

    Seq Age Sex Outcome Treatment
    1 18 YR Life Threatening