BEUDAMED
    FDA Adverse Event Death Summary report: N

    SEATBELT

    MDR report key: 20520 · Received January 20, 1995

    Report

    Report Number
    20520
    Event Type
    Death
    Date Received
    January 20, 1995
    Date of Event
    January 15, 1995
    Report Date
    January 20, 1995
    Manufacturer
    ITW NEXUS
    Product Code
    KNN
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    IN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT/PT WAS FOUND IN HER WHEELCHAIR. SHE HAD SLIPPED DOWN PARTIALLY OUT OF HER WHEELCHAIR ONTO HER KNEES WITH THE SEATBELT AROUND HER NECK AREA. THE CHARGE NURSE COULD NOT OBTAIN A PULSE, BLOOD PRESSURE OR RESPIRATIONS. CPR WAS INITIATED BUT IT WAS NOT SUCCESSFUL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SEATBELT SEATBELT FOR A WHEELCHAIR KNN ITW NEXUS FASTEX SR-2

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Death