BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CS 62

    MDR report key: 542248 · Received September 1, 2004

    Report

    Report Number
    1217116-2004-00017
    Event Type
    Injury
    Date Received
    September 1, 2004
    Date of Event
    August 6, 2004
    Report Date
    August 6, 2004
    Manufacturer
    PHILIPS MEDICAL SYSTEMS
    Product Code
    IYB
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    HI, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE PT WAS HAVING AN X-RAY EXAM. WHILE THE TECHNOLOGIST WAS POSITIONING THE CS 62, CEILING SUSPENSION SYSTEM, THE FRONT COVER FELL OFF. THE COVER STRUCK THE TECHNOLOGIST ON THE TOP OF THE HEAD RESULTING IN A HEAD WOUND REQUIRING STITCHES. ALSO, THE COVER STRUCK THE PT ON THE FACE CAUSING A CUT ON LEFT CHEEK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CS 62 DIAGNOSTIC X-RAY TUBE MOUNT IYB PHILIPS MEDICAL SYSTEMS 9804-182-20102 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other| R