BEUDAMED
    FDA Adverse Event Summary report: N

    JACKSON MODULAR TABLE SYSTEM

    MDR report key: 2573240 · Received April 24, 2012

    Report

    Report Number
    2921578-2011-00043
    Date Received
    April 24, 2012
    Report Date
    November 21, 2011
    Manufacturer
    MIZUHO OSI
    Product Code
    JEA
    Report Source
    Manufacturer report
    Reporter Location
    DA
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    HOSPITAL CONTACT AND DISTRIBUTOR FOR COMPLAINT AND OF TRAINING FOR STAFF.

    Description of Event or Problem · 1

    DURING SURGERY, HEALTHCARE WORKER REMOVED THE WRONG T-PIN AT THE HEAD-END OF THE TABLE. THE TABLE AND PATIENT FELL TO THE FLOOR. THE HEALTHCARE PERSON WHO CAUSED THIS EVENT WAS RETRAINED AND UNDERSTANDS THE SEVERITY OF THEIR ACTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JACKSON MODULAR TABLE SYSTEM ORTHOPEDIC TABLE JEA MIZUHO OSI 5803

    Patients

    Seq Age Sex Outcome Treatment
    1