BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WIDE SHOWER CHAIR

    MDR report key: 563687 · Received November 9, 2004

    Report

    Report Number
    MW1034094
    Event Type
    Malfunction
    Date Received
    November 9, 2004
    Date of Event
    November 2, 2004
    Report Date
    November 8, 2004
    Manufacturer
    IPU
    Product Code
    INM
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    OCCUPATIONAL THERAPIST

    Narratives

    Description of Event or Problem · 1

    PT TAKEN TO SHOWER VIA SHOWER CHAIR. UPON RETURN TO THE PT ROOM THE CHAIR COLLAPSED CAUSING PT TO SLIP. DID NOT FALL ON FLOOR. WAS ABLE TO TRANSFER PT TO PERSONAL WHEELCHAIR. UPON INVESTIGATION OF THE SHOWER CHAIR, THE WHEELCASTER WAS BENT AND IT BENT THE PVC PIPE ALSO WHICH HELD THE WHEEL. SUPPLY CO WAS CALLED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 WIDE SHOWER CHAIR WIDE SHOWER CHAIR 400 LB CAPACITY INM IPU SCC9250-03 *

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Other