BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PERSONAL BACK PLUS

    MDR report key: 73120 · Received March 3, 1997

    Report

    Report Number
    MW1010873
    Event Type
    Injury
    Date Received
    March 3, 1997
    Date of Event
    February 3, 1997
    Report Date
    February 19, 1997
    Manufacturer
    INVACARE CORP.
    Product Code
    IMS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NE, US
    Reporter Occupation
    OCCUPATIONAL THERAPIST

    Narratives

    Description of Event or Problem · 1

    BACK OF RESIDENT'S WHEELCHAIR FELL OFF. RESIDENT FELL BACKWARDS OUT OF CHAIR. STATED SHE HIT HER HED. NURSING STAFF TURNED THE WRONG WAY. DR'S OFFICE WAS NOTIFIED. IN EVENING OF DATE OF EVENT THE DAUGHTER SPOKE WITH HER MOTHER. RESIDENT STATED HER NECK WAS HURTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PERSONAL BACK PLUS BACK SUPPORT FOR WHEELCHAIR IMS INVACARE CORP. PPM18T *

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Required Intervention JAY 2 CUSHION,| ADJUSTABLE ARGYLE FOOTPLATES,| 18" HEMI HEIGHT W/C