BEUDAMED
    FDA Adverse Event Summary report: N

    LINEAR ACCELERATOR

    MDR report key: 11779 · Received February 28, 1994

    Report

    Report Number
    MW1000897
    Date Received
    February 28, 1994
    Date of Event
    February 1, 1994
    Report Date
    February 2, 1994
    Manufacturer
    VARIAN ASSOC., INC.
    Product Code
    IYE
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE RADIATION THERAPY TECHNOLOGIST WAS TREATING A PT WITH A 10 X 10 ELECTRON CONE. THE PT WAS TREATED AT A DIRECT LATERAL GANTRY ANGLE OF 270 DEGREES. THE GANTRY WAS THEN ROTATED 180 DEGREES, WITH THE ELECTRON CONE IN PLACE, TO A GANTRY ANGLE OF 90 DEGREES. THE THERAPY TECHNOLOGIST SET UP THE TREATMENT FIELD AND LEFT THE TREATMENT ROOM. AFTER SETTING THE SPECIFIED MONITOR UNITS AND SETTING THE CORRECT CODE FOR THE ELECTRON CONE, THE CONSOLE DISPLAYED TWO INTERLOCKS "WC" AND "COLL." THE THERAPIST WENT BACK INTO THE TREATMENT ROOM. ATTEMPTING TO CLEAR THE INTERLOCK FAULTS SHE MOVED THE TREATMENT TABLE AWAY FROM THE CONE. AS THE TABLE WAS MOVED THE CONE DISMOUNTED FROM THE TRAY ASSEMBLY HITTING HER RIGHT HAND AS IT FELL TO THE FLOOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LINEAR ACCELERATOR IYE VARIAN ASSOC., INC. CL.20

    Patients

    Seq Age Sex Outcome Treatment
    1 *