BEUDAMED
    FDA Adverse Event Other Summary report: N

    JACKSON TABLE

    MDR report key: 549230 · Received July 20, 2004

    Report

    Report Number
    MW1032767
    Event Type
    Other
    Date Received
    July 20, 2004
    Date of Event
    July 12, 2004
    Report Date
    July 20, 2004
    Manufacturer
    ORTHOPEDIC SYSTEMS, INC.
    Product Code
    HDD
    Report Source
    Voluntary report
    Reporter Location
    MD, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    CHEST SUPPORT PLATE BROKE DURING PROCEDURE. A SECOND SUPPORT PLATE WAS FOUND TO BE CRACKED AT THE SAME LOCATION THAT FIRST PLATE BROKE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JACKSON TABLE OR TABLE HDD ORTHOPEDIC SYSTEMS, INC. 5892 *

    Patients

    Seq Age Sex Outcome Treatment
    1 16 YR Other