BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PANACEA LAP SUPPORT

    MDR report key: 3112286 · Received July 12, 2006

    Report

    Report Number
    3112286
    Event Type
    Injury
    Date Received
    July 12, 2006
    Date of Event
    June 25, 2006
    Report Date
    June 30, 2006
    Manufacturer
    DIRECT SUPPLY
    Product Code
    FMQ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS BEING WHEELED DOWN HALLWAY TO BREAKFAST WHEN RESIDENT PUT FEET DOWN AND WHEELCHAIR SUDDENLY STOPPED - RESIDENT EJECTED OUT OF WHEELCHAIR WITH LAP BUDDY HITTING HEAD ON FLOOR - CAUSING 2X2 LACERATION TO FOREHEAD AND SENT TO EMERGENCY ROOM FOR STITCHES. FAILURE OF LAP BUDDY. BOUGHT LAP CUSHIONS THROUGH DIRECT SUPPLY - EMAILED REPORT TO (B)(4). DIRECT SUPPLY ASKING FOR INFORMATION ON MANUFACTURER, ETC. WANTS TO SEND CUSHIONS BACK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PANACEA LAP SUPPORT LAP SUPPORT FMQ DIRECT SUPPLY

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Other