BEUDAMED
    FDA Adverse Event Other Summary report: N

    TELETOM

    MDR report key: 539406 · Received August 13, 2004

    Report

    Report Number
    1220685-2004-00003
    Event Type
    Other
    Date Received
    August 13, 2004
    Date of Event
    July 20, 2004
    Report Date
    August 12, 2004
    Manufacturer
    BERCHTOLD CORP.
    Product Code
    FQO
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    A NURSE WAS ROTATING A TELETOM 363 POWER BOOM AND AN ERGOTRON ARM WITH A FLAT PANEL MONITOR FELL. THIS IMPACTED THEIR HEAD AND REQUIRED SIX STITCHES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TELETOM POWER BOOM FQO BERCHTOLD CORP. 363 *

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Hospitalization