inforMED
MalfunctionIOR

ROGUE

Received Jan 20, 2016 · Event occurred Jan 9, 2016

Report 3005905321-2016-01656 · MDR key 5380968

Device

Generic name

Rigid Wheelchair

Manufacturer

Ki Mobility

Model number

ROGUE

Catalog number

N/A

Lot number

N/A

Product problems

  • Break
  • Component Falling

Patient

36 YR

  • Fall
  • Head Injury
  • Fall
  • Head Injury

Narrative

Additional Manufacturer Narrative

WHEELCHAIR WILL BE RETURNED TO MANUFACTURER FOR EVALUATION TO DETERMINE THE CAUSE OF EVENT.

Description of Event or Problem

CUSTOMER CLAIMS THAT THE BACKREST BOLT SNAPPED WHERE THE POST CONNECTS TO THE SEAT CAUSING THE BACK TO FALL WHILE GOING DOWN A RAMP. END USER FELL INJURING HIS HEAD AND WAS HOSPITALIZED FOR A FEW DAYS, THE EXTENT OF THE INJURY HAS NOT BEEN COMMUNICATED BUT USER WAS RELEASED.

Remedial action

  • Replace
  • Repair