BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JUNO DRF

    MDR report key: 5080784 · Received September 16, 2015

    Report

    Report Number
    1217116-2015-00002
    Event Type
    Injury
    Date Received
    September 16, 2015
    Date of Event
    August 6, 2015
    Report Date
    August 6, 2015
    Manufacturer
    VILLA SISTEMI MEDICALI S.P.A.
    Product Code
    KXJ
    Adverse Event
    Yes
    Report Source
    Distributor report
    Reporter Location
    TX, US
    Reporter Occupation
    RADIOLOGIC TECHNOLOGIST

    Narratives

    Description of Event or Problem · 1

    PHILIPS WAS INFORMED BY A CUSTOMER THAT THE FOOTBOARD OF THE DEVICE DETACHED FROM THE TABLE TOP WHILE A PATIENT WAS POSITIONED ON THE TABLE. AS A RESULT THE PATIENT FELL FROM THE TABLE AND PATIENT'S HEAD AND BACK WAS INJURED. THE PATIENT WAS MOVED TO ER FOR EXAMINATION AND A MUSCLE RELAXANT WAS PRESCRIBED. THE PATIENT WAS ASKED FOR A FOLLOW UP VISIT AFTER A FEW DAYS

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    612655 JUNO DRF TABLE, RADIOLOGIC KXJ VILLA SISTEMI MEDICALI S.P.A. 709020

    Patients

    Seq Age Sex Outcome Treatment
    1 Other