BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    "TREE"

    MDR report key: 1222246 · Received October 29, 2008

    Report

    Report Number
    1222246
    Event Type
    Malfunction
    Date Received
    October 29, 2008
    Date of Event
    October 27, 2008
    Report Date
    October 29, 2008
    Manufacturer
    AMICO
    Product Code
    FOX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    OH, US

    Narratives

    Description of Event or Problem · 1

    AMICO HAS SUPPLIED COLUMNS WITH AN ATTACHMENT USED TO SUPPORT IVPUMPS WITH POWER. WE ARE CALLING THIS DEVICE A "TREE." THE COLUMN PROVIDES 120V POWER AND SUPPORT WHEN MOVING THE BED IN THE ROOM. THIS DEVICE CAN ALSO BE SUPPORTED BY THE BED FOR TRANSPORT. WHILE MOVING SOME DEVICE AROUND ON THE COLUMN, THE "TREE" FELL OUT OF THE MOUNT, DROPPING SEVERAL PUMPS TO THE FLOOR AND DAMAGING 5 UNITS. THE PATIENT WAS CONNECTED TO THERAPIES AT THE TIME OF THE INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 "TREE" PUMPS SUPPORT FOX AMICO * *

    Patients

    Seq Age Sex Outcome Treatment
    1 *