EASYSTAND BANTAM MEDIUM

Report

• Report Number: 2183634-2021-00002
• Event Type: Injury
• Date Received: August 11, 2021
• Date of Event: July 12, 2021
• Report Date: July 12, 2021
• Manufacturer: ALTIMATE MEDICAL, INC.
• Product Code: INO
• PMA / PMN Number: K123834
• Adverse Event: Yes
• Report Source: Manufacturer report
• Reporter Location: MO, US
• Reporter Occupation: 003

Narratives

Description of Event or Problem · 1

ALTIMATE MEDICAL, INC. WAS INFORMED BY ONE OF THEIR SALES REPRESENTATIVES ON (B)(6) 2021 THAT A CLIENT'S FATHER CLAIMED THEIR BANTAM MEDIUM STANDER WAS "FAULTY". THE FATHER SAID THE CLIENT WAS STANDING IN IT LAST WEEK AND THE TRAY FELL OFF AND SHE FELL OUT OF IT, INJURING HERSELF. HE STATED THAT THE TRAY WAS NOT ABLE TO SECURELY ATTACH TO THE STANDER.

Devices

Seq	Brand	Generic	Product Code	Manufacturer	Model	Lot	UDI-DI
1202766	EASYSTAND BANTAM MEDIUM	CHAIR, POSITIONING, ELECTRIC	INO	ALTIMATE MEDICAL, INC.	BANTAM MEDIUM

Patients

Seq	Age	Sex	Outcome	Treatment
1			Other

Terms

Patient problem · 1

• Fall

Product problems · 1

• Use of Device Problem

Source type · 1

• DISTRIBUTOR

Type of report · 1

• Initial submission