BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PVC SHOWER CHAIR ON 5" ROLLERS

    MDR report key: 37238 · Received September 11, 1996

    Report

    Report Number
    MW1009899
    Event Type
    Injury
    Date Received
    September 11, 1996
    Date of Event
    August 29, 1996
    Report Date
    September 6, 1996
    Manufacturer
    THE ANTHROS MEDICAL GROUP
    Product Code
    INM
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT CARE TECH WHEELED PT TO SHOWER ROOM IN "SHOWER CHAIR". BEFORE SHE STARTED UP RAMP, TECH HEARD "POP" SOUND, LEANED FORWARD AND TO THE RIGHT OF THE CHAIR, THEN THE CHAIR GAVE WAY PUSHING THE EMPLOYEE BACKWARDS WITH THE PT. THE CHAIR WENT FORWARD, SPILLING PT INTO SHOWER STALL. BACK RT WHEEL CRACKED AND BROKE, BOTH REINFORCEMENT AND PVC PIPE. PT STUCK HEAD ON TILE FLOOR AND C/O HEADACHE SHORTLY AFTER FALL. MULTIPLE BRUISES WITH NEG X-RAYS SUSTAINED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PVC SHOWER CHAIR ON 5" ROLLERS PVC SHOWER CHAIR ON 5" ROLLERS INM THE ANTHROS MEDICAL GROUP C552-XW T4P UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Required Intervention