BEUDAMED
    FDA Adverse Event Death Summary report: N

    E.M ADAMS CO, INC.

    MDR report key: 10655205 · Received October 9, 2020

    Report

    Report Number
    10655205
    Event Type
    Death
    Date Received
    October 9, 2020
    Date of Event
    June 1, 2020
    Report Date
    October 7, 2020
    Manufacturer
    E.M. ADAMS, INC.
    Product Code
    FMQ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PATIENT SNAPPED OFF RESTRAINTS, JUMPED OUT OF BED AND WENT THROUGH THE WINDOW.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1120983 E.M ADAMS CO, INC. RESTRAINT, PROTECTIVE FMQ E.M. ADAMS, INC. 70806-1 07-20

    Patients

    Seq Age Sex Outcome Treatment
    1 18615 DA Death