inforMED
InjuryFMP

FLOOR CUSHION, TWO-TONE

Received May 25, 2011 · Event occurred May 23, 2009

Report 2020362-2011-00164 · MDR key 2115184

Device

Manufacturer

J. T. Posey Co.

Model number

6021

Catalog number

6021

Lot number

UNK

Product problems

  • Unknown (for use when the device problem is not known)

Patient

NI

  • Bone Fracture(s)
  • Hematoma

Narrative

Description of Event or Problem

POSEY RECEIVED INFORMATION FROM A THIRD PARTY REPORT THAT ALLEGES AN EMPLOYEE SLIPPED ON A FLOOR MAT AND FELL TO THE FLOOR. THE EMPLOYEE SUSTAINED A SUBDURAL HEMATOMA, FRACTURED ELBOW, SHOULDER, WRIST AND KNEE INJURY.

Additional Manufacturer Narrative

(B)(4). POSEY HAS REQUESTED MORE INFORMATION AND THE RETURN OF THE PRODUCT, BUT HAS NOT RECEIVED ANY FURTHER INFORMATION OR PRODUCT. THIS REPORT IS BASED SOLELY ON INFORMATION PROVIDED BY A THIRD PARTY. (B)(4).