BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MULTI DIAGNOST 4 FOOT REST

    MDR report key: 420728 · Received October 2, 2002

    Report

    Report Number
    1217116-2002-00013
    Event Type
    Malfunction
    Date Received
    October 2, 2002
    Date of Event
    August 13, 2002
    Report Date
    September 30, 2002
    Manufacturer
    PHILIPS MEDICAL SYSTEMS NORTH AMERICA CO.
    Product Code
    IZO
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PATIENT WAS HAVING A UPPER GI DONE ON X-RAY. THE X-RAY TABLE WAS ROTATED VERTICALLY AND THE FOOTREST SUPPORTING THE PATIENT FELL OFF OF THE TABLE. PATIENT DID NOT FALL ON THE FLOOR BUT COMPLAINED OF BACK PAIN. NO PROBLEMS FOUND ON PELVIS AND HIP X-RAY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MULTI DIAGNOST 4 FOOT REST FOOT REST ACCESSORY DEVICE IZO PHILIPS MEDICAL SYSTEMS NORTH AMERICA CO. 9896-000-12221 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR Other