BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PVC

    MDR report key: 302255 · Received October 23, 2000

    Report

    Report Number
    302255
    Event Type
    Injury
    Date Received
    October 23, 2000
    Date of Event
    October 13, 2000
    Report Date
    October 19, 2000
    Manufacturer
    INNOVATIVE PRODUCTS UNLIMITED
    Product Code
    INM
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    WI, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    AT APPROX 0700 PT WAS PULLED INTO SHOWER STALL. THE TOP ON THE SHOWER CHAIR CAME OFF, CAUSING THE CHAIR TO LEAVE THE AIDE'S HANDS. THIS CAUSED THE RESIDENT TO FALL BACKWARD WHILE SITTING IN THE CHAIR. PT'S HEAD HIT THE AIDE'S SHOE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PVC SHOWER CHAIR INM INNOVATIVE PRODUCTS UNLIMITED SC 200 *

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Hospitalization