BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 3251394 · Received May 2, 2013

    Report

    Report Number
    3251394
    Event Type
    Malfunction
    Date Received
    May 2, 2013
    Date of Event
    October 1, 2012
    Report Date
    March 4, 2013
    Manufacturer
    BLICKMAN INC
    Product Code
    FOX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US

    Narratives

    Description of Event or Problem · 1

    POLE IS NOT STABLE. WHEN IV PUMP IS ON POLE, THE POLE WILL TIP OVER. THE MAIN CENTER POLE UNSCREWS EASILY AND FALLS. BASE IS NOT STABLE WHEN ROLLING. THE POLE TIPS. THE POLE FALLS WHEN GOING IN AND OUT OF ELEVATOR.WHAT WAS THE ORIGINAL INTENDED PROCEDURE?IV POLE.DEVICE #1IS THIS A LABORATORY DEVICE OR LABORATORY TEST?NO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    193795 * STAND, INFUSION FOX BLICKMAN INC * *

    Patients

    Seq Age Sex Outcome Treatment
    1 *