BEUDAMED
    FDA Adverse Event Summary report: N

    UNK

    MDR report key: 742941 · Received June 29, 2006

    Report

    Report Number
    MW1039562
    Date Received
    June 29, 2006
    Date of Event
    June 27, 2006
    Report Date
    June 29, 2006
    Manufacturer
    UNK
    Product Code
    IOR
    Report Source
    Voluntary report
    Reporter Location
    RI, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT WAS BEING TRANSPORTED TO MD APPOINTMENT IN W/C VAN. WHILE MAKING A TURN, THE DRIVER HEARD THE PT YELL, VAN WAS STOPPED. UPON INSPECTION, CHAIR (WHEEL) HAD SNAPPED IN TWO. THIS CAUSED PT TO HIT HEAD AND C/O ABDOMINAL PAIN AT SEATBELT SITE. PT SENT TO HOSP. DIAGNOSED WITH CONTUSION - RIB.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNK WHEEL CHAIR IOR UNK UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR