BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EVEREST & JENNINGS

    MDR report key: 615865 · Received June 21, 2005

    Report

    Report Number
    615865
    Event Type
    Injury
    Date Received
    June 21, 2005
    Date of Event
    April 25, 2005
    Report Date
    May 2, 2005
    Manufacturer
    EVERST & JENNINGS, INC.
    Product Code
    IOR
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    ND, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS TRANSFERRING SELF FROM TOILET TO WHEELCHAIR. THE BRAKES ON THE WHEELCHAIR FAILED TO HOLD THE CHAIR IN PLACE. RESIDENT FELL, LANDING ON THEIR LEFT HIP. XRAY REVEALED FRACTURE OF LEFT HIP. RESIDENT HAD PINNING OF LEFT HIP IN 2005. RESIDENT WAS A TRANSFER ASSIST OF ONE WITH STANDBY OR CONTACT GUARD ASSIST. RESIDENT STAY IN NURSING HOME SECONDARY TO STATUS POST ORIF OF RIGHT ANKLE RELATED TO A FALL AT HOME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EVEREST & JENNINGS WHEELCHAIR IOR EVERST & JENNINGS, INC. TRAVELER *

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR Hospitalization| O