BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JACKSON TABLE WITH FLAT TOP

    MDR report key: 7108282 · Received December 11, 2017

    Report

    Report Number
    MW5073898
    Event Type
    Injury
    Date Received
    December 11, 2017
    Date of Event
    November 21, 2017
    Report Date
    December 3, 2017
    Manufacturer
    MIZUHO OSI
    Product Code
    GDC
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MD, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    TABLE SLIGHTLY "AIRPLANED" BY CRNA, THEN TABLE STARTED TO MOTORIZE AND AIRPLANE FURTHER WITHOUT CONTROLLER BEING TOUCHED. ANM INSTRUCTED STAFF TO DISENGAGE ELECTRONIC BREAK, THEN RELEASE MANUAL BREAK WHICH STOPPED FURTHER MOTION. PT TRANSFERRED TO STANDARD BED. NO HARM REACHED THE PT. TABLE ASSESSED - HAND PIECE FOUND TO BE BROKEN - TABLE SENT OUT FOR REPAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    885885 JACKSON TABLE WITH FLAT TOP JACKSON TABLE WITH FLAT TOP GDC MIZUHO OSI

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Required Intervention