BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BASIC X-TRA TRACTION SHOE COVER

    MDR report key: 618040 · Received June 29, 2005

    Report

    Report Number
    9616096-2005-00041
    Event Type
    Injury
    Date Received
    June 29, 2005
    Date of Event
    June 2, 2005
    Report Date
    June 29, 2005
    Manufacturer
    KIMBERLY-CLARK CORP.
    Product Code
    FXP
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    AN INDIVIDUAL WAS WEARING THE SHOE COVER AND THE FLOOR WAS DRY AND HAD BEEN WAXED ONE WEEK EARLIER. THE INDIVIDUAL FELL AND REQUIRED KNEE SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BASIC X-TRA TRACTION SHOE COVER SHOE COVER FXP KIMBERLY-CLARK CORP. NA UNAVAILABLE

    Patients

    Seq Age Sex Outcome Treatment
    1 * Hospitalization