MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 1997-03-20 for 7684 LA VANGATOR LIFT 7684LA NA manufactured by Aequitron Medical, Inc..
[22084552]
User reclined his wheelchair to enter van from platform then in advertently activated the wheelchair forward, at full power, climbing over end barrier, falling to ground and breaking his foot.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2183897-1997-00004 |
| MDR Report Key | 78188 |
| Report Source | 07 |
| Date Received | 1997-03-20 |
| Date of Report | 1997-02-18 |
| Date of Event | 1997-02-17 |
| Date Mfgr Received | 1997-02-18 |
| Device Manufacturer Date | 1995-01-01 |
| Date Added to Maude | 1997-03-27 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| 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 | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 7684 LA VANGATOR LIFT |
| Generic Name | AUTOMATIC VAN LIFT |
| Product Code | ING |
| Date Received | 1997-03-20 |
| Model Number | 7684LA |
| Catalog Number | NA |
| Lot Number | NA |
| ID Number | NA |
| Operator | OTHER |
| Device Availability | N |
| Device Age | 2 YR |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 77823 |
| Manufacturer | AEQUITRON MEDICAL, INC. |
| Manufacturer Address | 14800 28TH AVE. NO. PLYMOUTH MN 55447 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 1997-03-20 |