BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EVERST & JENNINGS TRAVELER

    MDR report key: 66488 · Received January 6, 1997

    Report

    Report Number
    66488
    Event Type
    Malfunction
    Date Received
    January 6, 1997
    Date of Event
    December 20, 1996
    Report Date
    December 28, 1996
    Manufacturer
    EVERST & JENNINGS, INC.
    Product Code
    IOR
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    GA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS IN WHEELCHAIR AND RIGHT WHEEL CAME OFF OF CHAIR. RESIDENT SLID TO THE FLOOR. UPON INSPECTION OF WHEELCHAIR, BOLT WAS FOUND TO BE BROKEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EVERST & JENNINGS TRAVELER WHEELCHAIR IOR EVERST & JENNINGS, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR Other