BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INNOVATIVE PRODUCTS UNLIMITED, INC.

    MDR report key: 2393102 · Received December 23, 2011

    Report

    Report Number
    1833497-2011-00013
    Event Type
    Malfunction
    Date Received
    December 23, 2011
    Date of Event
    December 5, 2011
    Report Date
    December 23, 2011
    Manufacturer
    INNOVATIVE PRODUCTS UNLIMITED, INC.
    Product Code
    INM
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CT, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    RESIDENT WAS IN THE SHOWER CHAIR WHEN THE PIPE BELOW THE SEAT BROKE SENDING THE RESIDENT TO THE FLOOR. RESIDENT WAS NOT INJURED. SENT OUT A NEW CHAIR TO REPLACE THE BROKEN ONE. WILL INSPECT THE DAMAGED CHAIR WHEN WE GET IT BACK.

    Description of Event or Problem · 1

    RESIDENT WAS IN THE SHOWER CHAIR WHEN THE PIPE BELOW THE SEAT BROKE SENDING THE RESIDENT TO THE FLOOR. RESIDENT WAS NOT INJURED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INNOVATIVE PRODUCTS UNLIMITED, INC. SHOWER CHAIR INM INNOVATIVE PRODUCTS UNLIMITED, INC. SCC9250

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK