BEUDAMED
    FDA Adverse Event Other Summary report: N

    DUPACO PROME PILLOW

    MDR report key: 2680329 · Received June 2, 2012

    Report

    Report Number
    2921578-2012-00013
    Event Type
    Other
    Date Received
    June 2, 2012
    Date of Event
    June 6, 2012
    Report Date
    July 2, 2012
    Manufacturer
    DUPACO, INC.
    Product Code
    CCX
    Report Source
    Manufacturer report
    Reporter Location
    OK, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    SENT DATA TO MFR, DUPACO, INC.

    Description of Event or Problem · 1

    DURING USE OF THE DUPACO PRONE PILLOW D28503CE, TWO PTS HAD SKIN TEARS/ABRASIONS ON BOTH CHEEKS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUPACO PROME PILLOW PILLOW CCX DUPACO, INC. D28503CE UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 Other