BEUDAMED
    FDA Adverse Event Death Summary report: N

    EZ LIFT

    MDR report key: 1475053 · Received June 29, 2009

    Report

    Report Number
    1475053
    Event Type
    Death
    Date Received
    June 29, 2009
    Date of Event
    June 20, 2009
    Report Date
    June 29, 2009
    Manufacturer
    EZ WAY, INC.
    Product Code
    FSA
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING RESIDENT TRANSFER, WITH EZ LIFT, RESIDENT FELL BACK OUT OF LIFT, HITTING HIS HEAD ON THE FLOOR. RESIDENT EXPIRED AT THE HOSPITAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EZ LIFT EZ LIFT FSA EZ WAY, INC. 798 NA
    2 NORAM SOLUTIONS GENERAL PURPOSE SLING LARGE CUSTOM PADDED SLING W/HEAD SUPPORT FSA NORAM SOLUTIONS 100 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Death| H EZ LIFT| NORAM SOLUTIONS SLING