PRIDE MOBILITY PRODUCTS JAZZY SELECT ELITE N/A

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2020-02-05 for PRIDE MOBILITY PRODUCTS JAZZY SELECT ELITE N/A manufactured by Pride Mobility Products.

Event Text Entries

[177786171] This was not an issue with the product. The consumer was hit by a car while in product.
Patient Sequence No: 1, Text Type: N, H10


[177786172] Alleges she was crossing the street when a car turned into the right side of her device and hit her.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2530130-2020-00016
MDR Report Key9670505
Report SourceCONSUMER
Date Received2020-02-05
Date of Report2020-01-31
Date Mfgr Received2020-01-28
Device Manufacturer Date2019-04-10
Date Added to Maude2020-02-05
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMISS KELLY LIVINGSTON
Manufacturer Street401 YORK AVE
Manufacturer CityDURYEA PA 18642
Manufacturer CountryUS
Manufacturer Postal18642
Manufacturer Phone5706024056
Manufacturer G1N/A
Manufacturer StreetN/A N/A
Manufacturer CityN/A
Manufacturer CountryUS
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NamePRIDE MOBILITY PRODUCTS
Generic NamePOWERED WHEELCHAIR
Product CodeITI
Date Received2020-02-05
Model NumberJAZZY SELECT ELITE
Catalog NumberN/A
Lot NumberN/A
OperatorLAY USER/PATIENT
Device AvailabilityY
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerPRIDE MOBILITY PRODUCTS
Manufacturer Address401 YORK AVE DURYEA PA 18642 US 18642


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization 2020-02-05

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