AMERICAN STANDARD *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2001-06-04 for AMERICAN STANDARD * manufactured by *.

Event Text Entries

[223185] Resident on toilet. Found resident on floor and toilet laying sideways on floor. Resident sitting on toilet then found on floor by cna. Toilet overturned. Resident denied any injury.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: MW1022102
• MDR Report Key: 336579
• Date Received: 2001-06-04
• Date of Report: 2001-05-25
• Date of Event: 2001-05-24
• Date Added to Maude: 2001-06-12
• Event Key: 0
• Report Source Code: Voluntary report
• Manufacturer Link: N
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 0
• Health Professional: 3
• Initial Report to FDA: 0
• Report to FDA: 0
• Event Location: 3
• Single Use: 0
• Previous Use Code: 0
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: AMERICAN STANDARD
• Generic Name: TOILET
• Product Code: IKW
• Date Received: 2001-06-04
• Model Number: *
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Operator: LAY USER/PATIENT
• Device Availability: Y
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 325883
• Manufacturer: *
• Manufacturer Address: * * *

Patients

Patient Number	Treatment	Outcome	Date
1	0	1. Other	2001-06-04