BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    APOLLO 3 PORT

    MDR report key: 1902922 · Received November 12, 2010

    Report

    Report Number
    MW5018211
    Event Type
    Malfunction
    Date Received
    November 12, 2010
    Date of Event
    November 12, 2010
    Report Date
    November 12, 2010
    Manufacturer
    APOLLO 3 PORT WOUND CARE MANAGEMENT SYSTEM
    Product Code
    INX
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    BLUE CHIP-APOLLO 3 PORT WOUND CARE SYSTEM PUMP MALFUNCTION CAUSING THE MATTRESS TO DEFLATE AND RESIDENT SLID TO BOTTOM OF BED AND OUT OF THE BED. NO INJURY RESULTED FROM THE FALL BUT THE PUMP DID CAUSE THE CIRCUIT BREAKER TO TRIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 APOLLO 3 PORT BLUE CHIP INX APOLLO 3 PORT WOUND CARE MANAGEMENT SYSTEM 17078887

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Other