BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ARJO HOSPITAL EQUIPMENT

    MDR report key: 2973843 · Received February 13, 2009

    Report

    Report Number
    2973843
    Event Type
    Injury
    Date Received
    February 13, 2009
    Date of Event
    January 26, 2009
    Report Date
    February 13, 2009
    Product Code
    FSA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING ROUTINE CARE RESIDENT WAS LYING ON SIDE HOLDING ON TO SIDERAIL OF SHOWER TROLLEY HAVING BACK DRIED OFF. THE C.N.A. TURNED TO GET A DRY TOWEL AND HEARD A SNAP, SHE THEN TURNED BACK TO FIND RESIDENT FALLING FROM SHOWER TROLLEY. ALL SHOWER TROLLIES INSPECTED AND THOSE IN QUESTION REMOVED. NEW SHOWER TROLLIES ORDERED. ON THE ACTUAL SHOWER TROLLEY ADDRESS APPEARS AS FOLLOWS: (B)(6).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ARJO HOSPITAL EQUIPMENT SHOWER TROLLEY FSA 084000-04

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Hospitalization