FDA Adverse Event Malfunction Summary report: N

SIREGRAPH B FOOTBOARD

MDR report key: 2655 · Received January 11, 1993

Report

Report Number
2655
Event Type
Malfunction
Date Received
January 11, 1993
Date of Event
September 21, 1992
Report Date
December 24, 1992
Manufacturer
SIEMENS MEDICAL SYSTEMS, INC.
Product Code
KXJ
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

THE LOCKING PLATES WHICH SECURED THE FOOT REST TO THE TABLE IN ONE OF THE HOSPITAL'S FLUROSCOPY ROOMS DISENGAGED WHILE SUPPORTING A PATIENT'S WEIGHT RESULTING IN THE PATIENT FALLING TO THE FLOOR. THE OCCURENCE WAS REPORTED TO THE MANUFACTURER, WHO MADE A SITE VISIT ON DECEMBER 21, 1992. ADJUSTMENTS WERE MADE TO THE FOOT BOARD. IT WAS ALSO NOTED THAT THERE WAS A PROBLEM WITH THE FOOT BOARD U-CHANNELS BENDING. THIS WILL BE REPORTED TO THE MAIN COMPANY HEADQUARTERS IN GERMANYDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: FAIR CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-NOV-91. SERVICE PROVIDED BY: USER FACILITY BIOMEDICAL/BIOENGINEERING DEPARTMENT. SERVICE RECORDS AVAILABLE.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, MECHANICAL TESTS PERFORMED, PERFORMANCE TESTS PERFORMED, VISUAL EXAMINATION. RESULTS OF EVALUATION: COMPONENT FAILURE, DESIGN - INADEQUATE, MATERIAL DEGRADATION/DETERIORATION. CONCLUSION: DEVICE FAILURE DIRECTLY CAUSED EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE REPAIRED AND PUT BACK IN SERVICE, DEVICE TEMPORARILY REMOVED FROM SERVICE. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SIREGRAPH B FOOTBOARD KXJ SIEMENS MEDICAL SYSTEMS, INC. 8037715G2079

Patients

Seq Age Sex Outcome Treatment
1 80 YR Other