MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 1996-10-09 for PHILIPS CASSETTE HOLDER 9894-120-90009 NA manufactured by Philips Medical Systems.
[17414449]
Cassette holder for mounting on wall bucky fell off when bucky was raised. The cassette holder then nearly struck the pt but the technologist caught the cassette holder with her left hand resulting in her twisting her left wrist. Injury was minor and required no medical attention.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1217116-1996-00024 |
| MDR Report Key | 58380 |
| Report Source | 05 |
| Date Received | 1996-10-09 |
| Date of Event | 1996-09-25 |
| Date Facility Aware | 1996-09-25 |
| Report Date | 1996-09-26 |
| Date Mfgr Received | 1996-09-26 |
| Date Added to Maude | 1996-12-30 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| 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 | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NI |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PHILIPS CASSETTE HOLDER |
| Generic Name | WALL BUCKY CASSETTE HOLDER |
| Product Code | IXY |
| Date Received | 1996-10-09 |
| Model Number | 9894-120-90009 |
| Catalog Number | NA |
| Lot Number | NA |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | NO INFO |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 58837 |
| Manufacturer | PHILIPS MEDICAL SYSTEMS |
| Manufacturer Address | BEST, THE NETHERLANDS * * |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1996-10-09 |