BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BELMONT-BEL-20N

    MDR report key: 15040103 · Received July 18, 2022

    Report

    Report Number
    15040103
    Event Type
    Malfunction
    Date Received
    July 18, 2022
    Date of Event
    June 27, 2022
    Report Date
    July 12, 2022
    Manufacturer
    TAKARA BELMONT CORPORATION, OSAKA FACTORY
    Product Code
    NRU
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 0

    PATIENT WAS IN THE DENTISTRY CLINIC AND FELL OUT OF THE DENTAL CHAIR. THIS CHAIR DOES NOT HAVE A LOCKING MECHANISM ON THE ARMREST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2911014 BELMONT-BEL-20N CHAIR, DENTAL, WITHOUT OPERATIVE UNIT NRU TAKARA BELMONT CORPORATION, OSAKA FACTORY BEL-20N

    Patients

    Seq Age Sex Outcome Treatment
    1 2920 DA Female Other