BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DORNIER RELAX+ TABLE

    MDR report key: 1970976 · Received January 6, 2011

    Report

    Report Number
    1037955-2010-00025
    Event Type
    Malfunction
    Date Received
    January 6, 2011
    Report Date
    December 31, 2010
    Manufacturer
    DORNIER MEDTECH AMERICA, INC.
    Product Code
    LNS
    PMA / PMN Number
    P840008
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    A BRACKET THAT WAS SUPPORTING A STIRRUP ATTACHED TOA RELAX+ TABLE DETACHED FROM THE TABLE. THE STIRRUP WAS HOLDING THE LEG OF A (B)(6) PT. THE BRACKET DETACHED WHEN THE STIRRUP SUSTAINED AN IMPACT FROM A TECHNICIAN. THE PT'S LEG DROPPED BUT A TECHNICIAN CAUGHT THE LEG. THE PT WAS NOT INJURED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DORNIER RELAX+ TABLE PATIENT TABLE LNS DORNIER MEDTECH AMERICA, INC. K1018669

    Patients

    Seq Age Sex Outcome Treatment
    1 Other