MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-10-01 for DRIVE TITAN23C manufactured by Wu's Tech (vietnam) Co., Ltd..
[122300926]
(b)(4) healthcare is the initial importer of the device which is a power wheelchair. We are awaiting return of the device for evaluation. The end-user was descending a ramp when the seat detached. She fell and was reportedly diagnosed with a concussion and a hairline hip fracture. Rest was prescribed.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2438477-2018-00048 |
| MDR Report Key | 7922509 |
| Date Received | 2018-10-01 |
| Date of Report | 2018-10-01 |
| Date of Event | 2018-08-03 |
| Date Facility Aware | 2018-08-29 |
| Report Date | 2018-10-01 |
| Date Reported to FDA | 2018-10-01 |
| Date Reported to Mfgr | 2018-10-02 |
| Date Added to Maude | 2018-10-01 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | DRIVE |
| Generic Name | POWER MOBILITY |
| Product Code | INI |
| Date Received | 2018-10-01 |
| Model Number | TITAN23C |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | WU'S TECH (VIETNAM) CO., LTD. |
| Manufacturer Address | 31, VSIP II, ROAD 6, HOA PHU WARD TDM CITY, BINH DUONG VM |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-10-01 |