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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: PROVIDENCE; CHAIR, POSITIONING, ELECTRIC
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PROVIDENCE; CHAIR, POSITIONING, ELECTRIC Back to Search Results
Model Number 8626-12 MOCHA 486 MOCHA
Device Problem Protective Measures Problem (3015)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 03/12/2019
Event Type  No Answer Provided  
Event Description
This consumer is reporting a chair that he purchased for his disabled brother.This chair lifts a person to a stand up position and in his brother's case it is because he cannot lift himself.The brother dropped some sort of a plastic bottle around (b)(6) 2019 on the flow that went under the chair and when the brother used the chair to stand himself up the bottle under the chair damaged the mechanism under the chair.This caller states that he is creating the report because there is room for a child to crawl under the chair and he believes that if a child was under the chair, it could crush or otherwise injure that child.There are no injuries being reported.He contacted the mfr who told him that was like running over a nail in the road.Purchase date: 01/08/2019.(b)(4).
 
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Brand Name
PROVIDENCE
Type of Device
CHAIR, POSITIONING, ELECTRIC
MDR Report Key8527930
MDR Text Key142615949
Report NumberMW5085981
Device Sequence Number1
Product Code INO
Combination Product (y/n)N
Reporter Country CodeUS
Number of Events Reported1
Summary Report (Y/N)N
Report Source Voluntary
Reporter Occupation Patient Family Member or Friend
Type of Report Initial
Report Date 04/01/2019
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received04/17/2019
Device Operator No Information
Device Model Number8626-12 MOCHA 486 MOCHA
Was Device Available for Evaluation? Yes
Was Device Evaluated by Manufacturer? No Information
Type of Device Usage N
Patient Sequence Number1
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