BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SUPPORT ARM 177

    MDR report key: 1103603 · Received May 30, 2008

    Report

    Report Number
    1225700-2008-00076
    Event Type
    Malfunction
    Date Received
    May 30, 2008
    Date of Event
    May 21, 2008
    Report Date
    May 22, 2008
    Manufacturer
    MAQUET CRITICAL CARE AB
    Product Code
    MOD
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    JA
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE SUPPORT ARM WAS BEING ADJUSTED WHILE THE VENTILATOR WAS CONNECTED TO A PT. THE SUPPORT ARM BROKE AND HIT THE PT. THE EXTENT OF INJURY IS UNK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SUPPORT ARM 177 IOY MOD MAQUET CRITICAL CARE AB * *

    Patients

    Seq Age Sex Outcome Treatment
    1 *