FDA Adverse Event
Malfunction
Summary report: N
CHAIRMAN DENTAL CHAIR
MDR report key: 123965
·
Received September 26, 1997
Report
- Report Number
- 1017522-1997-00122
- Event Type
- Malfunction
- Date Received
- September 26, 1997
- Report Date
- September 26, 1997
- Manufacturer
- SIEMENS PELTON & CRANE
- Product Code
- KLC
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA
- Reporter Occupation
- DENTIST
Narratives
Description of Event or Problem · 1
DENTAL CHAIR BROKE. THE DR. SAID THAT HE WAS INCLINING A PATIENT UP IN THE CHAIR FOR AN X-RAY WHEN THE LIFT LINKAGE IN THE CHAIR BROKE CAUSING THE PATIENT TO FALL AND HIT THEIR HEAD ON THE REAR COUNTER TOP. THE PATIENT RECEIVED A SORE NECK AND A HEADACHE. THE CHAIR BACK WITH THE PATIENT ALSO FELL ON THE DENTAL ASSISTANT'S LEG CAUSING HER TO GET A CONTUSION ON HER LEG. THE DR. SAID THAT THERE WERE NO PERMANENT INJURIES TO NEITHER THE PATIENT NOR THE DENTAL ASSISTANT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | CHAIRMAN DENTAL CHAIR | DENTAL OPERATORY CHAIR | KLC | SIEMENS PELTON & CRANE | L1 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | NA |