BEUDAMED
    FDA Adverse Event Injury Summary report: N

    FLAMINGO

    MDR report key: 3173444 · Received May 2, 2013

    Report

    Report Number
    3001657382-2013-00003
    Event Type
    Injury
    Date Received
    May 2, 2013
    Date of Event
    April 6, 2013
    Report Date
    May 1, 2013
    Manufacturer
    R82 A/S
    Product Code
    INM
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FI
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THIS INFO IS ALSO SENT TO (B)(4), (B)(6), WHERE THE INCIDENT TOOK PLACE.

    Description of Event or Problem · 1

    "THE GIRL WAS SITTING ON THE CHAIR AND SHE SWINGS FORWARD/BACKWARD A LOT, WITHOUT ANY WARNING SEAT LOCKS UNDER THE SEAT BROKE, THE GIRL MOVES FORWARD AND THE WHOLE CHAIR TIPPED OVER AND GIRL HIT HER HEAD ON THE FLOOR OF THE SHOWER ROOM. THE TEETH COMING ON HER LIP AND THREE OF THEM ARE BROKEN."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    193556 FLAMINGO FLAMINGO INM R82 A/S 880003-NL

    Patients

    Seq Age Sex Outcome Treatment
    1 12 YR Hospitalization