BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BOUNDER

    MDR report key: 666228 · Received January 18, 2006

    Report

    Report Number
    2027797-2006-00001
    Event Type
    Injury
    Date Received
    January 18, 2006
    Manufacturer
    21ST CENTURY SCIENTIFIC, INC.
    Product Code
    ITI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CUSTOMER WAS DRIVING CHAIR DOWN ROAD. THE RIGHT FRONT FORK STEM BROKE. CAUSING THE CHAIR TO VEER TO THE RIGHT INTO A ROAD DITCH. THE CHAIR TIPPED OVER, LANDING ON TOP OF THE USER. THE USER WAS BELTED INTO THE CHAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BOUNDER POWER WHEELCHAIR ITI 21ST CENTURY SCIENTIFIC, INC. BIG BOUNDER *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Hospitalization