BEUDAMED
    FDA Adverse Event Death Summary report: N

    BED, HOSPITAL

    MDR report key: 954661 · Received November 27, 2007

    Report

    Report Number
    2182305-2007-00035
    Event Type
    Death
    Date Received
    November 27, 2007
    Date of Event
    September 4, 2007
    Report Date
    September 28, 2007
    Manufacturer
    JOERNS HEALTHCARE, INC.
    Product Code
    FNJ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED TO THE MANUFACTURER, BY FACILITY, LAKE MARION NURSING HOME, PER FACILITY ONE OF THEIR BEDS MOVED, SLIPPED OUT FROM UNDER A RESIDENT, WHILE THE RESIDENT WAS TRYING TO GET IN IT. FACILITY HAD TWO LOCKING CASTERS AND TWO NON LOCKING CASTERS AT THE TIME OF THE INCIDENT ON THEIR BEDS. FACILITY STATED, THE LOCKING CASTERS WERE LOCKED WHEN THE CASTER SWIVELED AND THE BED MOVED. WHEN THIS ACTION HAPPENED THE RESIDENT FELL AND HIT THEIR HEAD ON THE FLOOR, AND DIED LATER FROM HEAD TRAUMA. THE STATE OF SC INSPECTORS WAS IN THERE, REPORT IS STILL BEING INVESTIGATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BED, HOSPITAL BED, HOSPITAL, MANUAL FNJ JOERNS HEALTHCARE, INC. B784 EZC 2000 MANUAL

    Patients

    Seq Age Sex Outcome Treatment
    1 YR Death