BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RELIANCE

    MDR report key: 2000458 · Received February 17, 2011

    Report

    Report Number
    MW5019488
    Event Type
    Injury
    Date Received
    February 17, 2011
    Date of Event
    January 7, 2011
    Report Date
    February 17, 2011
    Manufacturer
    RELIANCE
    Product Code
    FRK
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    ELECTRICAL POWER CORD PLUGGED IN AT BASE OF EXAM CHAIR USED IN EYE CLINIC SHORTED OUT CAUSING SPARKS AND THEN SMOKE. THIS EVENT SET UP CODE RED HOSP WIDE FIRE SMOKE ALARM. EYE CLINIC WAS EVACUATED AND NO INJURIES WAS REPORTED AS A RESULT OF QUICK ACTION OF MEDICAL STAFF. DATES OF USE: (B)(6) 1997 ¿ (B)(6) 2011.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RELIANCE EXAM CHAIR FRK RELIANCE 700HF 1995

    Patients

    Seq Age Sex Outcome Treatment
    1 Other