*

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1998-11-05 for * manufactured by Unk.

Event Text Entries

[143011] Staff was pushing resident to main dining room, when leg rest on wheelchair became unlocked, causing resident to get caught under wheelchair. Resident fell to floor on her face. Retruned to distributor broken for their repair.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: MW1014901
• MDR Report Key: 195591
• Date Received: 1998-11-05
• Date of Report: 1998-11-02
• Date of Event: 1998-10-24
• Date Added to Maude: 1998-11-09
• Event Key: 0
• Report Source Code: Voluntary report
• Manufacturer Link: N
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 0
• Health Professional: 3
• Initial Report to FDA: 0
• Report to FDA: 0
• Event Location: 3
• Single Use: 0
• Previous Use Code: 0
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: *
• Generic Name: WHEELCHAIR LEG REST
• Product Code: IMM
• Date Received: 1998-11-05
• Model Number: *
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Operator: HEALTH PROFESSIONAL
• Device Availability: R
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 190025
• Manufacturer: UNK
• Manufacturer Address: UNK UNK *

Patients

Patient Number	Treatment	Outcome	Date
1	0	1. Other	1998-11-05