BEUDAMED
    FDA Adverse Event Death Summary report: N

    INNOVATIVE PRODUCTS UNLIMITED, INC.

    MDR report key: 635130 · Received September 13, 2005

    Report

    Report Number
    1833497-2005-00005
    Event Type
    Death
    Date Received
    September 13, 2005
    Report Date
    September 12, 2005
    Manufacturer
    INNOVATIVE PRODUCTS UNLIMITED, INC.
    Product Code
    INM
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MD, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PT WAS BEING TRANSPORTED TO SHOWER ROOM WITH NURSE ON THE LEFT SIDE OF CHAIR AND CNA WAS ON THE BACK/RIGHT SIDE OF THE CHAIR. WHEN NURSE AND CNA TOOK PT OUT IN THE HALLWAY FROM THEIR ROOM, THE FRONT LEFT CROSSBAR SEPARATED FROM THE JOINT AND CAUSED THE CHAIR TO SUDDENLY TILT DOWN AND FORWARDS ON THE LEFT SIDE. NURSE AND CNA HELD PT BODY AND ARM AS PT SLID OFF THE CHAIR AND ONTO THE FLOOR. NURSE AND CNA STATE AT THAT POINT THEY HAD NOT REALIZED THAT THE CROSSBAR HAD SEPARATED FROM THE JOINT. NURSE AND CNA PLACED PT BACK INTO CHAIR. NURSE AND CNA OBSERVED CHAIR WAS LEANING DOWN AND FORWARD ON THE LEFT SIDE AGAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INNOVATIVE PRODUCTS UNLIMITED, INC. SHOWER CHAIR-CHAIR WITH CASTERS INM INNOVATIVE PRODUCTS UNLIMITED, INC. UNK *

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Death| H