BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ACT II ASSISTANT STOOL

    MDR report key: 134597 · Received November 20, 1997

    Report

    Report Number
    1017522-1997-00130
    Event Type
    Malfunction
    Date Received
    November 20, 1997
    Report Date
    November 20, 1997
    Manufacturer
    SIEMENS PELTON & CRANE CO.
    Product Code
    FZM
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    DENTAL ASSISTANT

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE DR'S OFFICE THAT A DENTAL ASSISTANT WAS SITTING ON A ACT II ASSISTANT STOOL WHEN THE BOLT WHICH HOLDS THE STOOL'S BODY SUPPORT ARM BROKE. NO INJURIES WERE REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ACT II ASSISTANT STOOL DENTAL STOOP FZM SIEMENS PELTON & CRANE CO. E-1 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NA