MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2018-09-26 for PRIDE MOBILITY PRODUCTS SC610 VICTORY 10 3 WHEEL N/A manufactured by Pride Mobility Products.
[121851067]
The device has not yet been made available for evaluation. Should the device or further information become available, a follow-up report will then be issued.
Patient Sequence No: 1, Text Type: N, H10
[121851068]
Alleges going back into his building when the unit stopped. Alleges unit engaged itself and started going backwards. Alleges turning unit off and took out the key but it continued to go backwards. Alleges it went approximately 100 yards and then it hit a hole and tipped over and landed on him.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2530130-2018-00131 |
| MDR Report Key | 7911441 |
| Report Source | CONSUMER |
| Date Received | 2018-09-26 |
| Date of Report | 2018-09-24 |
| Date of Event | 2018-09-19 |
| Date Mfgr Received | 2018-09-20 |
| Device Manufacturer Date | 2016-12-16 |
| Date Added to Maude | 2018-09-26 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MISS KELLY LIVINGSTON |
| Manufacturer Street | 401 YORK AVE |
| Manufacturer City | DURYEA PA 18642 |
| Manufacturer Country | US |
| Manufacturer Postal | 18642 |
| Manufacturer Phone | 5706024056 |
| Manufacturer G1 | N/A |
| Manufacturer Street | N/A N/A |
| Manufacturer City | N/A |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PRIDE MOBILITY PRODUCTS |
| Generic Name | MOTORIZED THREE WHEELED VEHICLE |
| Product Code | INI |
| Date Received | 2018-09-26 |
| Model Number | SC610 VICTORY 10 3 WHEEL |
| Catalog Number | N/A |
| Lot Number | N/A |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PRIDE MOBILITY PRODUCTS |
| Manufacturer Address | 401 YORK AVE DURYEA PA 18642 US 18642 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2018-09-26 |