BEUDAMED
    FDA Adverse Event Death Summary report: N

    MJM

    MDR report key: 454154 · Received April 11, 2003

    Report

    Report Number
    MW1028144
    Event Type
    Death
    Date Received
    April 11, 2003
    Date of Event
    April 1, 2003
    Report Date
    April 11, 2003
    Manufacturer
    MJM
    Product Code
    ITJ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    AT 9:45 PM, REPORTED RESIDENT WAS ON THE FLOOR. NURSE CAME TO THE SCENE AND SAW RESIDENT ON THE FLOOR WITH THEIR LEGS INSIDE THE WALKING AID WHICH WAS TIPPED OVER. RESIDENT WAS UNABLE TO MOVE THEIR HEAD. HEAD WAS IMMOBILIZED. N.P. WAS CALLED TO GET ORDERS FOR TRANSFER TO HOSPITAL. 911 WAS CALLED FOR TRANSFER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MJM WHEELED PVC TYPE WALKING AID ITJ MJM UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 100 YR Death| H