UNKNOWN

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1994-02-04 for UNKNOWN manufactured by Everest Jennings Company.

Event Text Entries

[4779] On 8/6/93 at 1330, resident was sitting up in a w/c with a lap tray in place, when resident fell to floor. Resident suffered a 2 inch linear laceration on right forehead, bleeding from right nostril and a non-displaced fracture at base of left thumb. To be followed by an orthopedist. After all, it was noted that the velcro straps attached to the lap tray had come loose. After determination that the lap tray had been properly applied; closer inspection of lap tray revealed washers missing form screws securing the velcro strap which had come loose. The strap came off the screws, causing loosening of the whole lap tray, and subsequently led to residents fall. All lap trays of this type were immediately removed from use. Device not labeled for single use. Patient medical status prior to event: fair condition. There was not multiple patient involvement. Invalid data - on device service/maintenance. No data - regarding date last serviced. Service provided by: invalid data. Invalid data - service records availability. Imminent hazard to public health claimed. Device used as labeled/intended. Device was evaluated after the event. Method of evaluation: actual device involved in incident was evaluated, visual examination. Results of evaluation: material degradation/deterioration. Conclusion: device failure directly caused event. Certainty of device as cause of or contributor to event: yes. Corrective actions: use of all similar devices stopped permanently. Invalid data - on device destroyed/disposed of status.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number8293
MDR Report Key8293
Date Received1994-02-04
Date of Report1993-08-09
Date of Event1993-08-06
Date Facility Aware1993-08-06
Report Date1993-08-09
Date Reported to FDA1993-08-09
Date Reported to Mfgr1993-08-09
Date Added to Maude1994-08-08
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameUNKNOWN
Generic NameLAP TRAY
Product CodeIMX
Date Received1994-02-04
Model NumberUNKNOWN
Catalog NumberUNKNOWN
Lot NumberUNKNOWN
ID NumberUNKNOWN
OperatorOTHER HEALTH CARE PROFESSIONAL
Device AvailabilityY
Implant FlagN
Device Sequence No1
Device Event Key7968
ManufacturerEVEREST JENNINGS COMPANY


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 1994-02-04

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