BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EVEREST AND JENNINGS, INC.

    MDR report key: 507274 · Received January 9, 2004

    Report

    Report Number
    MW1030962
    Event Type
    Malfunction
    Date Received
    January 9, 2004
    Date of Event
    January 5, 2004
    Report Date
    January 9, 2004
    Manufacturer
    EVEREST & JENNINGS, INC.
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    OBESE PT WAS SITTING IN WHEELCHAIR WITH LEG ELEVATED ON LEG REST. THE CALF REST BROKE AND THE PT'S LEG FELL TO THE FLOOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EVEREST AND JENNINGS, INC. WHEELCHAIR IOR EVEREST & JENNINGS, INC. NONE NONE

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR Other