BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GE

    MDR report key: 627326 · Received August 9, 2005

    Report

    Report Number
    627326
    Event Type
    Malfunction
    Date Received
    August 9, 2005
    Date of Event
    February 15, 2005
    Report Date
    August 9, 2005
    Manufacturer
    GENERAL ELECTRIC COMPANY
    Product Code
    DQK
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    TN, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A 20-INCH CRT-TYPE MONITOR AND MOUNTING BRACKET FELL FROM THE 4-MONITOR BOOM ON WHICH IT WAS MOUNTED. FROM A HEIGHT OF APPROXIMATELY FIVE FEET THE MONITOR ASSEMBLY LANDED ON THE FLOOR. IT HIT THE HEALTH CARE PRACTITIONER AND BRUISED THE SHOULDER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GE MONITOR DQK GENERAL ELECTRIC COMPANY * *

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR