BEUDAMED
    FDA Adverse Event Other Summary report: N

    @BATH BENCH, BACK, ASSEMBLED, 2EA

    MDR report key: 1055441 · Received May 21, 2008

    Report

    Report Number
    1417592-2008-00012
    Event Type
    Other
    Date Received
    May 21, 2008
    Date of Event
    April 25, 2008
    Report Date
    May 20, 2008
    Manufacturer
    MEDLINE INDUSTRIES, INC.
    Product Code
    INM
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE END USER WAS USING THE BATH BENCH AND REPORTED THAT HE LEANED ON THE BACK AND THE BACK APPARENTLY GAVE AWAY. HE FELL AND HIT HIS HEAD. NO REPORT OF LOSS OF CONSCIOUSNESS. HE DID NOT SEEK MEDICAL ATTENTION UNTIL TWO DAYS LATER. BASED ON HIS REPORT OF HEADACHE AND NAUSEA, HIS PHYSICIAN INDICATED HE MAY HAVE HAD A MILD CONCUSSION. HE WAS NOT HOSPITALIZED AND NO FURTHER MEDICAL INTERVENTION WAS INDICATED. SAMPLE RECEIVED AND EVALUATED. IT APPEARS THE END USER MAY HAVE LEANED BACK WITH EXCESSIVE FORCE, CAUSING THE SEAT BACK TO SNAP AWAY FROM THE FRAME.

    Description of Event or Problem · 1

    END USER WAS USING THE BATH BENCH AND LEANED BACK, CAUSING THE SEAT TO SNAP FROM THE FRAME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 @BATH BENCH, BACK, ASSEMBLED, 2EA NONE INM MEDLINE INDUSTRIES, INC. MDS89745A R06127243

    Patients

    Seq Age Sex Outcome Treatment
    1 60+ Other