BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IDI

    MDR report key: 12180746 · Received July 15, 2021

    Report

    Report Number
    MW5102585
    Event Type
    Injury
    Date Received
    July 15, 2021
    Date of Event
    July 13, 2021
    Report Date
    July 14, 2021
    Manufacturer
    IMAGE DIAGNOSTICS, INC.
    Product Code
    MMZ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    GA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PATIENT HAD UNDERGONE A SURGICAL PROCEDURE. THE PROCEDURE WAS COMPLETE. THE STAFF ROLLED THE PATIENT TO HIS RIGHT SIDE TO PLACE THE ROLLER BOARD UNDER THE PATIENT TO TRANSFER THE PATIENT TO A STRETCHER. THE TABLE ABRUPTLY SHIFT TO THE SIDE AND THEN COLLAPSED WITH A STAFF MEMBER UNDER THE TABLE. THE REMAINING STAFF WERE ABLE TO SUPPORT THE PATIENT AND SAFELY TRANSFER THE PATIENT TO A STRETCHER. THE PATIENT WAS NOT INJURED. THE STAFF MEMBER WAS TAKEN TO THE ER FOR EVALUATION, TREATED AND RELEASED. THE TABLE HAS BEEN TAKEN OUT OF USE AND HAS BEEN SEQUESTERED. THE SURGICAL TABLE WAS MANUFACTURED BY IMAGE DIAGNOSTICS, INC., (B)(4). PHONE NUMBER (B)(4). THE MODEL NUMBER IS IDI 100UC. LOT NUMBER D100-1940B. SERIAL NUMBER (B)(4). CATALOG NUMBER 1874. FDA SAFETY REPORT ID# (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1075067 IDI TABLE, CYSTOMETRIC, ELECTRIC MMZ IMAGE DIAGNOSTICS, INC. IDI 100UC D100-1940B

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR Other