BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ALLEN STIRRUP

    MDR report key: 660988 · Received December 19, 2005

    Report

    Report Number
    MW1037443
    Event Type
    Malfunction
    Date Received
    December 19, 2005
    Date of Event
    October 28, 2005
    Report Date
    November 10, 2005
    Manufacturer
    VALLEY TECH
    Product Code
    EYD
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PATIENT HAD BEEN PLACED IN ALLEN STIRRUPS FOR A PROCEDURE. AS THE NURSE WAS PREPARING WITH THE SURGICAL PREP, SHE HEARD A SNAP. THE STIRRUP FELL TO THE FLOOR. IT APPEARS THAT THE SPOT WELD HOLDING THE BOOT TO THE STEM GAVE WAY. NO APPARENT INJURY TO THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALLEN STIRRUP ALLEN STIRRUP EYD VALLEY TECH * *

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR