BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CHATTANOOGA BALANCE SYSTEM DYNAMIC BALANCE MACHINE

    MDR report key: 137474 · Received December 10, 1997

    Report

    Report Number
    137474
    Event Type
    Injury
    Date Received
    December 10, 1997
    Date of Event
    December 8, 1997
    Report Date
    December 9, 1997
    Manufacturer
    CHATTANOOGA CORP.
    Product Code
    GWW
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    PT WAS BEING TESTED ON THE BALANCE MACHINE, LOST HIS BALANCE AND FELL BACKWARDS (HARNESS WAS ON AND SECURED). BELT GAVE WAY AT ADJUSTER SITE. (BUCKLE STAYED TOGETHER).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CHATTANOOGA BALANCE SYSTEM DYNAMIC BALANCE MACHINE BALANCE MACHINE GWW CHATTANOOGA CORP. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Hospitalization