BEUDAMED
    FDA Adverse Event Other Summary report: N

    SKYTRON ELITE 6500NB

    MDR report key: 516268 · Received March 17, 2004

    Report

    Report Number
    1825014-2004-00001
    Event Type
    Other
    Date Received
    March 17, 2004
    Date of Event
    January 23, 2004
    Report Date
    February 19, 2004
    Manufacturer
    SKYTRON
    Product Code
    FQO
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE FACILITY UTILIZED A NON-SKYTRON POWERCORD ASSEMBLY WHICH WAS INSERTED INTO A 120 VOLT WALL RECEPTACLE AT THE TIME THE USER ATTEMPTED TO PLUG IT INTO THE TABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SKYTRON ELITE 6500NB SURGICAL TABLE FQO SKYTRON T02-6500NB *

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Other