BEUDAMED
    FDA Adverse Event Injury Summary report: N

    NORCO EXERCIS LOOP ATTACHMENT

    MDR report key: 2620792 · Received June 8, 2012

    Report

    Report Number
    2939821-2012-00017
    Event Type
    Injury
    Date Received
    June 8, 2012
    Date of Event
    January 7, 2009
    Report Date
    June 7, 2012
    Manufacturer
    NORTH COAST MEDICAL, INC.
    Product Code
    ION
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    (B)(6) 2009, WHILE VACATIONING AT (B)(6), PT WAS PERFORMING EXERCISES PRESCRIBED BY OPTM SPORTS THERAPY USING THERA-BAND EXERCISE 24 BANDS AND A NORTH COAST EXERCISE LOOP (AKA THE DOOR ANCHOR). WHILE PERFORMING THE PRESCRIBED EXERCISES, THE NORTH COAST EXERCISE LOOP SNAPPED THROUGH THE DOOR AND STRUCK PT'S LEFT EYE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NORCO EXERCIS LOOP ATTACHMENT DOOR ANCHOR ION NORTH COAST MEDICAL, INC. NC91231-50 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NI Other