BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRANSPORT CHAIR

    MDR report key: 5635121 · Received May 5, 2016

    Report

    Report Number
    1417592-2016-00054
    Event Type
    Injury
    Date Received
    May 5, 2016
    Date of Event
    March 13, 2016
    Report Date
    May 5, 2016
    Manufacturer
    MEDLINE INDUSTIRES, INC.
    Product Code
    INM
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    Narratives

    Additional Manufacturer Narrative · 1

    THE END USER'S DAUGHTER REPORTED THAT WHILE SITTING IN THE TRANSPORT CHAIR, THE RIGHT LEG BROKE AND THE END USER FELL. SHE WAS TAKEN TO THE HOSPITAL AND HAD X-RAYS TAKEN OF HER LEGS, SHOULDER AND HIP. SHE WAS DIAGNOSED WITH A FRACTURE IN HER RIGHT CLAVICLE. A SOFT SLING WAS APPLIED AND PAIN MEDICATION GIVEN. SHE WAS DISCHARGED TO HOME. PHOTOS THAT WERE PROVIDED SHOWED THE RIGHT BACKREST TUBE WAS FRACTURED BELOW THE FOLDING MECHANISM. A SAMPLE HAS NOT BEEN RECEIVED FOR EVALUATION. THE LOT NUMBER HAS NOT BEEN PROVIDED. THE OVERALL CARE AND CONDITION OF THE TRANSPORT CHAIR IS NOT KNOWN. WE HAVE NO INFORMATION TO INDICATE A MANUFACTURING DEFECT CAUSED OR CONTRIBUTED TO THE INCIDENT. A ROOT CAUSE HAS NOT BEEN DETERMINED. DUE TO THE REPORTED INJURY, THIS MEDWATCH IS BEING FILED.

    Description of Event or Problem · 1

    THE END USER'S DAUGHTER REPORTED THAT HER MOTHER WAS SITTING IN THE TRANSPORT CHAIR AND THE RIGHT LEG BROKE AND SHE FELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    289140 TRANSPORT CHAIR INM MEDLINE INDUSTIRES, INC. UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 87 YR Other