BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BUCKY DIAGNOST TH

    MDR report key: 512203 · Received February 17, 2004

    Report

    Report Number
    1217116-2004-00004
    Event Type
    Injury
    Date Received
    February 17, 2004
    Date of Event
    January 15, 2004
    Report Date
    January 23, 2004
    Manufacturer
    PHILIPS MEDICAL SYSTEMS
    Product Code
    KPR
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PATIENT FELL OFF X-RAY TABLE WHEN MOMENTARILY LEFT ALONE. PATIENT BROKE THEIR HIP FROM THE FALL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BUCKY DIAGNOST TH STATIONARY X-RAY SYSTEM KPR PHILIPS MEDICAL SYSTEMS 9848-500-22402 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR Other| R