BEUDAMED
    FDA Adverse Event Death Summary report: N

    QUICKIE QM710

    MDR report key: 7115555 · Received December 13, 2017

    Report

    Report Number
    2937137-2017-00036
    Event Type
    Death
    Date Received
    December 13, 2017
    Date of Event
    December 5, 2017
    Report Date
    December 10, 2017
    Manufacturer
    SUNRISE MEDICAL (US) LLC
    Product Code
    ITI
    UDI-DI
    05022408052363
    PMA / PMN Number
    K083249
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THIS INCIDENT WAS REPORTED IN THE (B)(4) 2017 ISSUE OF THE (B)(4). SENIOR CONSTABLE (B)(4), OF THE METROPOLITAN CRASH INVESTIGATION UNIT IN (B)(4) REPORTED THE INCIDENT TO SUNRISE MEDICAL VIA EMAIL ON SUNDAY, (B)(6) 2017. SENIOR CONSTABLE (B)(4)'S ONLY REQUEST WAS FOR THE CONTACT INFORMATION OF OUR FACILITY IN (B)(4) AND ALSO INFORMATION ON HOW THE POWER WHEELCHAIR OPERATES TO INCLUDE IN THE CORONER'S REPORT. THIS INCIDENT WAS DEEMED AS AN ACCIDENT AND NO FURTHER INVESTIGATION OF THE CHAIR WILL BE PERFORMED.

    Description of Event or Problem · 1

    ON TUESDAY, (B)(6) 2017 A (B)(6) YEAR OLD END USER WAS IN A QM710 POWER CHAIR ON A BUSY ROAD IN (B)(6). AS HE WAS CROSSING AN INTERSECTION, HE WAS HIT BY A (B)(6) TRUCK, DRAGGING HIM UNDERNEATH. HE DIED AT THE SCENE OF THE ACCIDENT OF HIS INJURIES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    891991 QUICKIE QM710 POWER WHEELCHAIR ITI SUNRISE MEDICAL (US) LLC EIPW11 05022408052363

    Patients

    Seq Age Sex Outcome Treatment
    1 16 YR Death