FDA.reportPublic FDA data

MAUDE MDR 402729

MDR report key
402729
Report number
MW1025466
Event key
0
Event type
3
Date of event
2002-05-24
Date received
2002-06-20
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Report source
P
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1KINEDYNETIEDOWN STRAP FOR WHEELCHAIRSURE-LOK, INC.IQB***NY

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12002-06-2001. O

Event Narratives#

D

Patient 1

TIEDOWN STRAP SECURING WHEELCHAIR IN THE TRANSPORTATION. VAN FAILED WHEN THE SPRING IN THE LATCH ON THE STRAP POPPED OUT OF POSITION. THE WHEELCHAIR OVERTURNED CAUSING A BUMP TO THE RIGHT SIDE OF THE RESIDENT'S HEAD AND A SKIN TEAR TO THE RIGHT ELBOW.