BEUDAMED
    FDA Adverse Event Other Summary report: N

    AMIGO RD

    MDR report key: 737057 · Received August 9, 2005

    Report

    Report Number
    1821729-2005-00002
    Event Type
    Other
    Date Received
    August 9, 2005
    Date of Event
    July 15, 2005
    Report Date
    August 5, 2005
    Manufacturer
    AMIGO MOBILITY INTL., INC.
    Product Code
    INI
    Report Source
    Manufacturer report
    Reporter Location
    MI
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    CUSTOMER ALLEGED THAT UPON OPENING VAN TO EXIT OUT, SHE WENT FORWARD AND THEN REVERSE AND HIT THE CURB AND TIPPED OVER.

    Description of Event or Problem · 1

    WHILE GETTING OUT OF HER CAR, THE CUSTOMER WENT TO DRIVE FORWARD AND THEN IN REVERSE AND WHILE IN REVERSE THE AMIGO TOOK OFF AND DIDN'T STOP UNTIL IT HIT A CURB AND THEN TIPPED OVER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AMIGO RD MOTORIZED SCOOTER WITH SEAT INI AMIGO MOBILITY INTL., INC. 310000 *

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other