FDA Adverse Event Injury Summary report: N

SIEMENS 1.5T MRI MACHINE

MDR report key: 6092229 · Received November 8, 2016

Report

Report Number
MW5065941
Event Type
Injury
Date Received
November 8, 2016
Date of Event
November 4, 2016
Report Date
November 8, 2016
Manufacturer
SIEMENS
Product Code
LNH
Adverse Event
Yes
Report Source
Voluntary report
Reporter Location
AZ, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Description of Event or Problem · 1

ON (B)(6) 2016 AT APPROXIMATELY 0056 HOURS - AFTER THE TRAFFIC STOP, I DROVE TO THE (B)(6) BUILDING LOCATED AT (B)(6) TO CONDUCT A BUILDING CHECK. AS I CHECKED THE BUILDING, I LOCATED AN UNLOCKED DOOR THAT WAS PARTIALLY OPEN. I INFORMED THE (B)(6) POLICE DISPATCHER OF THE OPEN DOOR AND ASKED FOR AN ADDITIONAL OFFICER TO ASSIST IN CLEARING THE BUILDING. SHORTLY AFTER THE REQUEST, OFFICERS (B)(6) ARRIVED AT THE SCENE. THE (B)(6) POLICE DISPATCHER WAS INFORMED THAT WE WERE GOING TO BE MAKING ENTRY INTO THE UNLOCKED DOOR. THE (B)(6) OFFICERS CLEARED THE VERY LARGE MEDICAL BUILDING, WE DID NOT LOCATE ANYONE INSIDE. AS WE GOT TO THE EAST END OF THE INTERIOR, WE CAME UPON A DOOR THAT WAS PARTIALLY CLOSED. I WALKED UP AND HELD SECURITY ON A LONG HALLWAY THAT HAD NOT YET BEEN CLEARED AND OFFICER (B)(6) ENTERED TO CLEAR IT. INSIDE OF THIS ROOM WAS A LARGE MRI MACHINE. THERE WAS A NOISE COMING FROM THE OUTSIDE OF THE ROOM, BUT HAVING LIMITED EXPERIENCE WITH THIS TYPE OF MACHINE, THE SOUND WAS NOT ONE THAT I WAS FAMILIAR WITH AND DID NOT THINK THE MACHINE WAS OPERATING. AS OFFICER (B)(6) ENTERED THE ROOM TO CLEAR BEHIND THE MRI MACHINE, I HEARD A CRASHING SOUND, WHICH MADE ME THINK SOMETHING HAD BEEN KNOCKED OVER. I LOOKED IN THE ROOM TO CHECK ON OFFICER (B)(6) AND HIS HANDS WERE UP AND HE WAS NOT HOLDING HIS FIREARM. I ASKED OFFICER (B)(6) IF HE WAS ALRIGHT. OFFICER (B)(6) INFORMED ME THAT HIS ISSUED FIREARM HAD BEEN FORCED OUT OF HIS HANDS AND WAS NOW STUCK INSIDE OF THE MRI MACHINE. AS I WAS ALSO LOOKING FOR AN EMERGENCY SHUT OFF SWITCH I WAS ABLE TO SEE WHAT LOOKED LIKE AN EMERGENCY SHUT OFF SWITCH INSIDE OF THE ROOM, BUT WAS UNABLE TO GET TO IT AT THAT TIME. I THEN OBSERVED OFFICER (B)(6) LEAN TOWARDS THE MACHINE TO CHECK HIS FIREARM. AS OFFICER (B)(6) DID THIS, HE WAS SUCKED INTO THE SIDE OF THE MACHINE. OFFICER (B)(6) ATTEMPTED SEVERAL TIMES TO FREE HIMSELF FROM THE MACHINE, BUT WAS NOT SUCCESSFUL. OFFICER (B)(6) TOLD ME THAT HE WAS STUCK AND WAS UNABLE TO MOVE. I INFORMED OFFICER (B)(6) OF THE SITUATION, AND HE WAS ABLE TO GO AROUND A SMALL WALL OUT OF DANGER AND LOCATE AN EMERGENCY SHUT OFF SWITCH FOR THE MACHINE. APPROXIMATELY 30 SECONDS AFTER THE EMERGENCY SHUT OFF BUTTON PRESSED, OFFICER (B)(6) WAS ABLE TO GET FREE AND WAS TO GET SERVICE WEAPON OUT OF THE MACHINE. AFTER LOOKING AT OFFICER (B)(6), HE DID NOT APPEAR TO BE INJURED. OFFICER (B)(6) CHECKED HIS EQUIPMENT AND NOTHING APPEARED TO BE DAMAGED. OFFICER (B)(6) LOOKED AT THE MRI MACHINE AND HE INFORMED ME THAT THERE DID NOT APPEAR TO BE ANY DAMAGE TO THE MACHINE. AFTER OFFICERS FINISHED CLEARING THE REST OF THE BUILDING, WE LEFT THE BUILDING FROM THE SAME DOOR THAT WE HAD ENTERED FROM. I CONTACTED THE ON-DUTY SUPERVISOR WHO RESPONDED SHORTLY AFTER AND THEN ATTEMPTED TO CONTACT (B)(6), WHO IS THE LISTED RESPONSIBLE PARTY FOR THE BUILDING. DR. (B)(6) DID NOT ANSWER HIS PHONE SO A MESSAGE WAS LEFT FOR HIM. I THEN CONTACTED THE (B)(6) RISK MANAGER AND INFORMED HER OF WHAT HAD HAPPENED. I EXPLAINED THE SITUATION AND TOLD HER THAT THERE WAS NO OBVIOUS DAMAGE TO THE MACHINE AND OFFICER (B)(6) WAS NOT INJURED. AT THE CONCLUSION OF THE INCIDENT, IT APPEARED THAT THE DOOR WAS LEFT UNSECURED UNINTENTIONALLY AND THERE WERE NO SIGNS OF FORCED ENTRY. THERE WAS NO ALARM TO THE BUILDING THAT SOUNDED THE ENTIRE TIME THE OFFICERS WERE INSIDE. THE RESPONSIBLE PARTY HAS NOT BEEN CONTACTED AT THE TIME OF THIS REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
736631 SIEMENS 1.5T MRI MACHINE 1.5T MRI MACHINE LNH SIEMENS

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention