MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-09-15 for 360-91BH SIDE CHAIR PL9-12 manufactured by Nemschoff.
[55018365]
Psych-safe chair was used as a projectile and thrown by patient. Chair then shattered into 17 pieces, 12 were sharp and jagged wooden sticks. The patient then used the sticks to stab holes in the sheetrock, damaged the overhead lighting, and disrupt the sprinkler system.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | MW5064787 |
| MDR Report Key | 5955754 |
| Date Received | 2016-09-15 |
| Date of Report | 2016-09-15 |
| Date of Event | 2016-09-08 |
| Date Added to Maude | 2016-09-16 |
| Event Key | 0 |
| Report Source Code | Voluntary report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 0 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | 360-91BH SIDE CHAIR |
| Generic Name | CHAIR |
| Product Code | INM |
| Date Received | 2016-09-15 |
| Model Number | 360-91BH |
| Catalog Number | PL9-12 |
| Lot Number | 160617-320635003 |
| Operator | LAY USER/PATIENT |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | NEMSCHOFF |
| Manufacturer Address | SHEBOYGAN WI 53082 US 53082 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2016-09-15 |