BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNABLE TO DETERMINE

    MDR report key: 5479696 · Received June 10, 2005

    Report

    Report Number
    5479696
    Event Type
    Injury
    Date Received
    June 10, 2005
    Date of Event
    May 10, 2005
    Report Date
    June 9, 2005
    Product Code
    IOE
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    VT, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS WORKING AT THE PARALLEL BARS WHEN THE BAR ON THE LEFT SLID INWARD CAUSING HER TO FALL. THE RESIDENT STRUCK THE BACK OF HER HEAD ON THE OTHER BAR. NO INJURY RESULTED. THE SCREW HOLDING THE BAR AT THE JOINT HAD COME LOOSE. SHE HAD BEEN WORKING AT THE BARS FOR APPROX. 10 MINUTES WHEN THE BAR SLID. MAINTENANCE DEPT SECURED BARS - ADDITIONAL SAFETY SCREWS ADDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNABLE TO DETERMINE PARALLEL BARS IOE

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR