CDRH MEDICAL DEVICE REPORTING SYSTEM 13-FEB-96

EVENT REPORT DETAIL LISTING Page: 9
FOI RELEASABLE FORMAT
SORTED BY MEDICAL SPECIALTY & PRODUCT CODE
RECORDS MEETING QUERY CRITERIA

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PRP Report No: MwlOOO462 Date Received: 21-JAN-94
Reporting Facility Type: VOLUNTARY
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PATIENT INFORMATION

Age: 68 YR. DOB: 23-AUG-25 Sex: M Weight: 68kgs/l5OLbs

ADVERSE EVENT OR PRODUCT PROBLEM

Adverse Event: N Product Problem: *
Outcomes attributed to event: POOR MEMORY FOR NAMES

Event Date: Date of Report: 10-JAN-94

Event Description:

AFTER WORKING 13 MOS FOR THE POST OFFICE IN 1943 RPTR QUIT BECAUSE HE HAD SCIATIC PAINS IN BACK OF BOTH THIGHS AND FELT UNEASY WHEN HE MET PEOPLE. SHORTLY BEFORE HE QUIT SCHOOL AFTER ONE YR. OF NIGHT COLLEGE WHERE HE PASSED ALL SUBJECTS. HIS FAMILY TRIED TO HELP HIM BY SENDING HIM TO A PSYCHIATRIST WHO DID NOT REVEAL HIS PROFESSION TO HIM. SOON AFTER, RPTR'S FAMILY SENT HIM TO AN ALLEGED REST HOME WHICH TURNED OUT TO BE PSYCHIATRIC FACILITY. RPTR HAD 18 ELECTRIC SHOCK TREATMENTS. RPTR HAD THE SAME SYMPTOMS WHEN HE WAS DISCHARGED AS WHEN ADMITTED.

Other Related History:

DEPRESSION AND SCHIZOPHRENIA

DEVICE IDENTIFICATION

Brand:ELECTRIC SHOCK MACHINE
Generic:
Product Code: GxC(NE) - DEVICE, ELECTROCONVULSIVE THERAPY

Manufacturer: MEDCRAFT
Short name:MEDCRAFT
Address:
DARIEN, CT 06820

Model:
Catalog