BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDLINE INDUSTRIES

    MDR report key: 1424806 · Received July 24, 2009

    Report

    Report Number
    1424806
    Event Type
    Malfunction
    Date Received
    July 24, 2009
    Date of Event
    July 14, 2009
    Report Date
    July 24, 2009
    Manufacturer
    MEDLINE INDUSTRIES
    Product Code
    INB
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US

    Narratives

    Description of Event or Problem · 1

    PATIENT WAS SITTING ON A BRAND NEW BARIATRIC COMMODE CHAIR WHEN THE WHEEL BUCKLED/BROKE, WHICH TILTED THE COMMODE SIDEWAYS CAUSING THE PT TO SLIP OUT OF THE CHAIR ONTO THE FLOOR (NO INJURY). THIS COMMODE IS ABLE TO HOLD UP TO 700 POUNDS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDLINE INDUSTRIES COMMODE CHAIR, BARIATRIC INB MEDLINE INDUSTRIES PVCM1315 *

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR