BEUDAMED
    FDA Adverse Event Injury Summary report: N

    T-MAX SHOULDER POSITIONER

    MDR report key: 3009805 · Received March 18, 2013

    Report

    Report Number
    1643264-2013-00007
    Event Type
    Injury
    Date Received
    March 18, 2013
    Date of Event
    May 19, 2009
    Report Date
    February 18, 2013
    Manufacturer
    SMITH & NEPHEW OKLAHOMA CITY MANUFACTURING SITE
    Product Code
    GBB
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    THE CLAIMANT WAS WORKING AT (B)(6), IN THE SURGERY ROOM AS AN ANESTHESIA TECHNICIAN ON (B)(6) 2009. A PATIENT WAS BEING PREPPED FOR SURGERY AND WAS TRANSFERRED FROM A GURNEY TO A SURGICAL TABLE WHEN THE SURGICAL TABLE STARTED TO COLLAPSE. (B)(6) ATTEMPTED TO PREVENT THE TABLE FROM COLLAPSING AND INJURING THE PATIENT, AND INJURED HERSELF INSTEAD. ADDITIONAL INFORMATION CONFIRM (B)(6) SUFFERED BACK DISC INJURY AND UNDERWENT SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    112926 T-MAX SHOULDER POSITIONER RFB, T-MAX II, SHOULDER POSITIONER GBB SMITH & NEPHEW OKLAHOMA CITY MANUFACTURING SITE

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention