BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SHOWER STOOL

    MDR report key: 65677 · Received January 30, 1997

    Report

    Report Number
    MW1010635
    Event Type
    Injury
    Date Received
    January 30, 1997
    Date of Event
    September 20, 1996
    Report Date
    September 23, 1996
    Manufacturer
    DIV OF LUMINEX, INC.
    Product Code
    INN
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS FINISHED WITH SHOWER 9/20/96 AM RESTED ON CHAIR IN SHOWER ROOM. PT WAS PUTTING ON HER BLOUSE WHEN LEGS OF CHAIR GAVE WAY AND RESIDENT FELL AND PUT RT HAND OUT. NO C/O OF PAIN IMMEDIATELY AFTER FALL, ABLE TO STAND AND AMBULATE WITH WALKER AND NO LOC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SHOWER STOOL SHOWER STOOL INN DIV OF LUMINEX, INC. 7923 *

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention