MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2005-03-17 for LC MONITOR SUPPORT 2122371 NA manufactured by Ge Medical Systems Scs.
[409953]
A 20 inch crt-type monitor and mounting bracket fell from the 4-monitor boom on which it was mounted. From a height of approximately five feet the monitor assembly landed on the floor. It hit the hcp and bruised their shoulder.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9611343-2005-00009 |
| MDR Report Key | 585142 |
| Report Source | 05 |
| Date Received | 2005-03-17 |
| Date of Report | 2005-03-17 |
| Date of Event | 2005-02-15 |
| Date Mfgr Received | 2005-02-15 |
| Date Added to Maude | 2005-03-29 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Manufacturer Contact | MARY OVERLAND, PH.D. |
| Manufacturer Street | 3000 N. GRANDVIEW BLVD. W-400 |
| Manufacturer City | WAUKESHA WI 53188 |
| Manufacturer Country | US |
| Manufacturer Postal | 53188 |
| Manufacturer Phone | 2625482402 |
| Manufacturer G1 | GE MEDICAL SYSTEMS SCS |
| Manufacturer Street | 283 RUE DE LA MINIERE BP 34 |
| Manufacturer City | BUC CEDEX 78533 |
| Manufacturer Country | FR |
| Manufacturer Postal Code | 78533 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LC MONITOR SUPPORT |
| Generic Name | DIAGNOSTIC X-RAY |
| Product Code | IYB |
| Date Received | 2005-03-17 |
| Model Number | 2122371 |
| Catalog Number | NA |
| Lot Number | NA |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 574970 |
| Manufacturer | GE MEDICAL SYSTEMS SCS |
| Manufacturer Address | 283 RUE DE LA MINIERE BP 34 BUC CEDEX FR 78533 |
| Baseline Brand Name | LC MONITOR SUPPORT |
| Baseline Generic Name | DIAGNOSTIC X-RAY |
| Baseline Model No | 2122371 |
| Baseline Catalog No | NA |
| Baseline ID | NA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2005-03-17 |