BEUDAMED
    FDA Adverse Event Death Summary report: N

    DRIVE MEDICAL

    MDR report key: 902314 · Received August 24, 2007

    Report

    Report Number
    2438477-2007-00004
    Event Type
    Death
    Date Received
    August 24, 2007
    Date of Event
    July 20, 2006
    Report Date
    July 26, 2007
    Manufacturer
    MEDICAL DEPOT, INC. (D/B/A DRIVE MEDICAL DESIGN & MFG)
    Product Code
    INI
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    NO ADD'L INFO IS AVAILABLE AT THIS TIME.

    Description of Event or Problem · 1

    USER WAS RIDING ON AND OPERATING THE SCOOTER ON THE SIDEWALK, AT WHICH POINT THE SCOOTER, ALLEGEDLY SPED UP, WITHOUT WARNING, CAUSING THE USER TO LOSE CONTROL, LEAVE THE SIDEWALK, TURN ONTO THE STREET, WHICH IS A SIX INCH DROP-OFF, AND CAUSING THE SCOOTER TO OVERTURN. AS A RESULT OF WHICH, THE USER WAS ALLEGEDLY THROWN FROM THE SCOOTER ONTO THE STREET CAUSING HER SEVERE PERSONAL INJURIES. THE USER WAS HOSPITALIZED AFTER THE INCIDENT, AND DECEASED AT A LATER TIME. CAUSE OF DEATH IS UNKNOWN TO THE MANUFACTURER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DRIVE MEDICAL POWER SCOOTER, 4-WHEEL INI MEDICAL DEPOT, INC. (D/B/A DRIVE MEDICAL DESIGN & MFG) ODYSSEY NA

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Death