BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PICKER INTERNATIONAL, INC.

    MDR report key: 512066 · Received February 13, 2004

    Report

    Report Number
    512066
    Event Type
    Malfunction
    Date Received
    February 13, 2004
    Date of Event
    December 3, 2003
    Report Date
    February 9, 2004
    Manufacturer
    PHILLIPS MEDICAL SYSTEM
    Product Code
    KXJ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NY, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    FOOTBOARD ON X-RAY TABLE BROKE AND PT SLID TO THE FLOOR. SMALL SKIN LACERATION ON RIGHT LEG. X-RAY SYSTEM WAS PURCHASED IN 1990.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PICKER INTERNATIONAL, INC. CONTROL X-RAY SYSTEM KXJ PHILLIPS MEDICAL SYSTEM VECTOR 80 *

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Other