BEUDAMED
    FDA Adverse Event Other Summary report: N

    DELTA

    MDR report key: 730125 · Received June 23, 2005

    Report

    Report Number
    1220063-2005-00011
    Event Type
    Other
    Date Received
    June 23, 2005
    Date of Event
    May 26, 2005
    Report Date
    May 26, 2005
    Manufacturer
    DRAEGER MEDICAL SYSTEMS, INC.
    Product Code
    DSI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    THE REPORTED INCIDENT IS UNDER INVESTIGATION.

    Description of Event or Problem · 1

    THE CUSTOMER REPROTED A DELTA BEDSIDE PT MONITOR AND IV POLE MONITOR MOUNT BECAME SEPERATED FROM THE IV POLE IT WAS CONNECTED TO. THE PT MONITOR AND MOUNT FELL ONTO A TABLE. THE IV POLE SHOWED VISUAL INTENTS, WHERE THE MOUNTING CLAMP WAS SECURED. NO PT OR USER INJURY REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DELTA BEDSIDE PT MONITOR DSI DRAEGER MEDICAL SYSTEMS, INC. MS13464 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NA MONITOR DOCKING STATION IV POLE MOUNT