MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-08-30 for CHAIR AND TABLE, MEDICAL manufactured by Champion Manufacturing Inc..
[83984770]
Patient Sequence No: 1, Text Type: N, H10
[83984771]
Patient attempted to put footrest of reclining chair down and reach for his call bell. The chair tipped forward and the patient slid to the floor off of the recliner.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 6830511 |
| MDR Report Key | 6830511 |
| Date Received | 2017-08-30 |
| Date of Report | 2017-08-04 |
| Date of Event | 2017-08-02 |
| Report Date | 2017-08-04 |
| Date Reported to FDA | 2017-08-04 |
| Date Reported to Mfgr | 2017-08-04 |
| Date Added to Maude | 2017-08-30 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| 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 | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Generic Name | CHAIR AND TABLE, MEDICAL |
| Product Code | KMN |
| Date Received | 2017-08-30 |
| Operator | LAY USER/PATIENT |
| Device Availability | Y |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | CHAMPION MANUFACTURING INC. |
| Manufacturer Address | 2601 INDUSTRIAL PKWY. ELKHART IN 46516 US 46516 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-08-30 |