MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor report with the FDA on 2018-10-09 for PRIDE MOBILITY PRODUCTS SC710V VICTORY 10 3 WHEEL VA N/A manufactured by Pride Mobility Products.
[123116742]
The exact "date of event" has not been provided. The device has not been made available for evaluation at this time. Should the device or further information become available, a follow-up report will then be issued.
Patient Sequence No: 1, Text Type: N, H10
[123116743]
Alleges starting to go in reverse and the unit wouldn't stop going in reverse. Alleges hitting a flower bed and tipped backwards and unit tipped on top of consumer.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2530130-2018-00142 |
| MDR Report Key | 7948115 |
| Report Source | DISTRIBUTOR |
| Date Received | 2018-10-09 |
| Date of Report | 2018-10-04 |
| Date Mfgr Received | 2018-10-04 |
| Device Manufacturer Date | 2017-11-22 |
| Date Added to Maude | 2018-10-09 |
| 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 | 2018-10-09 |
| Model Number | SC710V VICTORY 10 3 WHEEL VA |
| Catalog Number | N/A |
| Lot Number | N/A |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| 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 | 2018-10-09 |