BEUDAMED
    FDA Adverse Event Other Summary report: N

    KINEDYNE

    MDR report key: 402729 · Received June 20, 2002

    Report

    Report Number
    MW1025466
    Event Type
    Other
    Date Received
    June 20, 2002
    Date of Event
    May 24, 2002
    Report Date
    June 20, 2002
    Manufacturer
    SURE-LOK, INC.
    Product Code
    IQB
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    TIEDOWN STRAP SECURING WHEELCHAIR IN THE TRANSPORTATION. VAN FAILED WHEN THE SPRING IN THE LATCH ON THE STRAP POPPED OUT OF POSITION. THE WHEELCHAIR OVERTURNED CAUSING A BUMP TO THE RIGHT SIDE OF THE RESIDENT'S HEAD AND A SKIN TEAR TO THE RIGHT ELBOW.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KINEDYNE TIEDOWN STRAP FOR WHEELCHAIR IQB SURE-LOK, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 89 YR Other