BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 3251515 · Received May 2, 2013

    Report

    Report Number
    3251515
    Event Type
    Injury
    Date Received
    May 2, 2013
    Date of Event
    February 15, 2013
    Report Date
    March 4, 2013
    Manufacturer
    BLICKMAN INC
    Product Code
    FOX
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US

    Narratives

    Description of Event or Problem · 1

    THE IV POLE IS UNSTEADY AND FREQUENTLY BEGINS TO TIP OVER. THE SMALL WHEELS ALSO GET CAUGHT IN GROOVES ON THE FLOOR AND IN ELEVATORS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    193801 * STAND, INFUSION FOX BLICKMAN INC * *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Required Intervention IV PUMP WITH CONNECTIONS| LONG-TERM ANTIBIOTICS