BEUDAMED
    FDA Adverse Event Injury Summary report: N

    INX FOR INLINE WITH DWL

    MDR report key: 12762993 · Received November 7, 2021

    Report

    Report Number
    1523574-2021-00016
    Event Type
    Injury
    Date Received
    November 7, 2021
    Date of Event
    October 22, 2021
    Report Date
    November 5, 2021
    Manufacturer
    FERNO-WASHINGTON, INC.
    Product Code
    FPO
    UDI-DI
    00019090001339
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    THE DEVICE WAS EVALUATED BY THE CUSTOMER WITH NO PRODUCT ISSUES FOUND. THE PATIENT ALLEGED INJURY IS BEING ATTRIBUTED TO THE MOTOR VEHICLE ACCIDENT. NO FURTHER DETAILS WERE PROVIDED.

    Description of Event or Problem · 0

    THE CUSTOMER REPORTED THE STRETCHER WAS INVOLVED IN A MOTOR VEHICLE ACCIDENT WHILE TRANSPORTING A PATIENT. THE CUSTOMER ADVISED THE STRETCHER REMAINED LOCKED WITHIN THE FASTENER THROUGHOUT THE ACCIDENT. THERE HAS BEEN NO ALLEGATION OF A PRODUCT MALFUNCTION. THE PATIENT IS ALLEGING BACK PAIN, SOLELY, AS A RESULT OF THE MOTOR VEHICLE ACCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1655215 INX FOR INLINE WITH DWL INX FOR INLINE WITH DWL FPO FERNO-WASHINGTON, INC. 0015811 00019090001339

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Other