BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 45904 · Received October 25, 1996

    Report

    Report Number
    45904
    Event Type
    Malfunction
    Date Received
    October 25, 1996
    Date of Event
    October 23, 1996
    Report Date
    October 25, 1996
    Manufacturer
    CONTINENTAL X-RAY CORP.
    Product Code
    KXJ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    FLUOROSCOPY TABLE MALFUNCTIONED CAUSING PT TO SLIDE OFF FOOT END OF TABLE STRIKING HIS HEAD. PT ALSO SUSTAINED LACERATIONS. TREATED IN ER AND RELEASED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * RF TABLE KXJ CONTINENTAL X-RAY CORP. 6806.101 *

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR DEVICE EVALUATED BY MFR, DAMAGED CHAIN TAKEN TO| FACTORY FOR ANALYSIS