BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AMERICAN STANDARD

    MDR report key: 336579 · Received June 4, 2001

    Report

    Report Number
    MW1022102
    Event Type
    Malfunction
    Date Received
    June 4, 2001
    Date of Event
    May 24, 2001
    Report Date
    May 25, 2001
    Manufacturer
    *
    Product Code
    IKW
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    RESIDENT ON TOILET. FOUND RESIDENT ON FLOOR AND TOILET LAYING SIDEWAYS ON FLOOR. RESIDENT SITTING ON TOILET THEN FOUND ON FLOOR BY CNA. TOILET OVERTURNED. RESIDENT DENIED ANY INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    25658 AMERICAN STANDARD TOILET IKW * * *

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Other