BEUDAMED
    FDA Adverse Event Death Summary report: N

    RECOVERCARE STAT 4 AP

    MDR report key: 3021017 · Received March 19, 2013

    Report

    Report Number
    MW5029475
    Event Type
    Death
    Date Received
    March 19, 2013
    Date of Event
    March 9, 2013
    Report Date
    March 19, 2013
    Manufacturer
    PRIMATECH MEDICAL SYSTEMS
    Product Code
    FNM
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WI, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    NURSING HOME RESIDENT FELL OUT OF BED ONTO TILE FLOOR RESULTING IN FRACTURED RIBS AND DISLOCATED SHOULDER. AIR MATTRESS WAS BEING USED ON THE BED FOR PRESSURE RELIEF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    114297 RECOVERCARE STAT 4 AP RECOVERCARE STAT 4 AP FNM PRIMATECH MEDICAL SYSTEMS SR309-3A-04-17 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR Death