BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RECLINER

    MDR report key: 17450 · Received November 7, 1994

    Report

    Report Number
    MW1003921
    Event Type
    Injury
    Date Received
    November 7, 1994
    Date of Event
    October 21, 1994
    Report Date
    October 26, 1994
    Manufacturer
    WINCO, INC.
    Product Code
    INN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS OOB VIA RECLINER WHEN, WHILE BEING PROPELLED, THE LEFT SIDE OF THE RECLINER BROKE OFF. RESIDENT RECEIVED RIGHT TEMPORAL LACERATION 3 X 1 1 1/2 CM REQUIRING SUTURES, LEFT HAND LACERATION 2 1/2 X 1 CM, AND RIGHT ELBOW LACERATION 3 1/2 X 2 CM. ALSO COMPLAINED OF TOOTH PAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RECLINER RECLINER INN WINCO, INC. 520

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Hospitalization