BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TELETOM 363

    MDR report key: 381374 · Received February 25, 2002

    Report

    Report Number
    1220685-2002-00001
    Event Type
    Malfunction
    Date Received
    February 25, 2002
    Date of Event
    January 7, 2002
    Report Date
    February 21, 2002
    Manufacturer
    BERCHTOLD CORP.
    Product Code
    KMI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MI, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    A MONITOR POSITIONED ON A TELETOM 363 POWER BOOM FELL OFF THE TOP SHELF OF THE BOOM STRIKING A PT IN THE PELVIC REGION. THE BOOM WAS SAID TO BE LEARNING SLIGHTLY AT A DOWNWARD ANGLE WHEN A NURSE REPOSITIONED THE BOOM WHICH LED TO THE MONITOR TILTING FORWARD AND FALLING OFF THE BOOM AND STRIKING THE PT CAUSING BRUISING TO THE PELVIC REGION. THE MONITOR IS NORMALLY STRAPPED TO THE SHELF, BUT THE STRAP HAD BEEN REMOVED BY HOSP PERSONNEL CLEANING THE ROOM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TELETOM 363 POWER BOOM KMI BERCHTOLD CORP. 363 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Other