BEUDAMED
    FDA Adverse Event Death Summary report: N

    HAUSTED ALL PRUPOSE CHAIR

    MDR report key: 560954 · Received December 16, 2004

    Report

    Report Number
    1043572-2004-00006
    Event Type
    Death
    Date Received
    December 16, 2004
    Date of Event
    November 28, 2004
    Report Date
    December 15, 2004
    Manufacturer
    STERIS CORPORATION - MONTGOMERY
    Product Code
    FZK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE PT QUADRAPLEGIC, WAS BEING TRANSFERRED BY 2 STAFF MEMBERS, USING A SHEET TRANSFER, FROM A HOSPITAL BED TO THE APC CHAIR WHEN THE PT'S ARM FELL TO THE SIDE. STAFF MEMBER LEANED OVER TO SECURE ARM. BECAUSE OF THEIR SIZE, STAFF HAD THEIR KNEE BRACED UP ON CHAIR, ACCIDENTALLY HIT THE BRAKE RELEASE ON THE APC CHAIR, WHICH THEN SEPARATED FROM THE HOSPITAL BED AND THE PT FELL THROUGH, STRIKING THEIR HEAD ON THE FLOOR. PT WAS ALERT FOR SOME TIME, THEN SLIPPED INTO UNCONSCIOUSNESS AND NEVER RECOVERED. PT DIED AT HOSPITAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HAUSTED ALL PRUPOSE CHAIR MANUAL OPERATING CHAIR AND ACCESSORIES FZK STERIS CORPORATION - MONTGOMERY 2662795 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Death 3.