BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    NA

    MDR report key: 563445 · Received September 20, 2004

    Report

    Report Number
    MW1034009
    Event Type
    Malfunction
    Date Received
    September 20, 2004
    Date of Event
    September 11, 2004
    Report Date
    September 13, 2004
    Manufacturer
    NA
    Product Code
    INM
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THIS RESISTANT WAS IN THE SHOWER CHAIR WHEN THE LEG OF THE CHAIR BROKE. THE RESISTANT WAS LOWERED TO THE FLOOR TO "BREAK" A POTENTIAL FALL. THE RESISTANT DID NOT SUSTAIN ANY INJURY. SHOWER CHAIR WAS REMOVED FROM SERVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NA EXTRA LARGE SHOWER CHAIR (CHAIR SEATED 400 LBS) INM NA NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other