BEUDAMED
    FDA Adverse Event Injury Summary report: N

    GOLDEN LITE RIDER SCOOTER

    MDR report key: 6692663 · Received July 6, 2017

    Report

    Report Number
    MW5070828
    Event Type
    Injury
    Date Received
    July 6, 2017
    Date of Event
    March 20, 2017
    Report Date
    June 11, 2017
    Manufacturer
    GOLDEN TECHNOLOGIES / GOLDEN BROTHERS, INC.
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    WHEN DESCENDING A RAMP, MY 2 MONTH-OLD SCOOTER CAME APART AND THREW ME ONTO A CEMENT WALK. (I HAD DESCENDED, AND ASCENDED, THE SAME RAMP IN THE SAME SCOOTER SEVERAL DAYS EARLIER WITH NO TROUBLE.) LEFT HIP BROKEN. ALSO STRUCK HEAD. A REPLACEMENT FOR (B)(4) WHICH WAS DEFECTIVE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    470400 GOLDEN LITE RIDER SCOOTER GOLDEN LITE RIDER SCOOTER INI GOLDEN TECHNOLOGIES / GOLDEN BROTHERS, INC. GL 111

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR Hospitalization| R| S