BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDICHOICE

    MDR report key: 4253561 · Received November 7, 2014

    Report

    Report Number
    MW5039073
    Event Type
    Injury
    Date Received
    November 7, 2014
    Date of Event
    October 13, 2014
    Report Date
    November 7, 2014
    Manufacturer
    PHILIPS BURTON
    Product Code
    KZF
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PATIENT HAS BEEN SEEN IN CONVENIENT CARE FOR STITCHES. PATIENT WAS LYING ON EXAM TABLE AND PHYSICIAN MOVED THE PORTABLE (ON WHEELS) EXAM LIGHT CLOSER TO COMPLETE TREATMENT. EXAM LIGHT EASILY BECAME UNBALANCED AND FELL OVER ON PATIENT, STRIKING THEM IN THE MOUTH AND INJURING THE MOUTH (UPPER LIP) AND TEETH. PATIENT HAD LACERATION AND REFUSED STITCHES. PATIENT SUBSEQUENTLY WENT TO DENTIST AND MAY LOSE FRONT TEETH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    719286 MEDICHOICE MOBILE EXAM LIGHT KZF PHILIPS BURTON LGHT7400A/LED
    719287 MEDICHOICE MOBILE EXAM LIGHT KZF PHILIPS BURTON LGHT7400/LED

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other