FDA Adverse Event
Injury
Summary report: N
130 ACORN T700 RH USA
MDR report key: 15175420
·
Received August 5, 2022
Report
- Report Number
- 3003124453-2022-00008
- Event Type
- Injury
- Date Received
- August 5, 2022
- Date of Event
- December 2, 2021
- Report Date
- August 5, 2022
- Manufacturer
- ACORN STAIRLIFTS, INC.
- Product Code
- PCD
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AL, US
- Reporter Occupation
- 003
Narratives
Additional Manufacturer Narrative · 0
ATTACHMENTS: INVESTIGATION REPORT, WORK COMPLETION REPORT.
Description of Event or Problem · 0
ON (B)(6) 2021. THE CUSTOMER CONTACTED ACORN STAIRLIFTS, INC. (ACORN) BECAUSE THE UPPER SAFETY COVER ON THE STAIRLIFT WAS LOOSE. ON (B)(6) 2021, THE CUSTOMER CONTACTED ACORN TO COMMUNICATE HAT HIS WIFE HAD FALLEN USING THE STAIRS. SPECIFICALLY, THE INCIDENT OCCURRED ON (B)(6) 2021 AFTER HE CONTACTED ACORN ABOUT THE SAFETY COVER BEING LOOSE. HIS ACCOUNT IS THAT HIS WIFE WAS WALKING DOWN THE STAIRS, SHE FELL AND SHE WAS WEDGED UNDER THE RAIL RESULTING IN STITCHES IN BOTH ARMS, BOTH KNEES AND HER LEFT HIP. THE CUSTOMER DID CLAIM THAT THE STAIRLIFT WAS NOT WORKING AT THE TIME OF THE INCIDENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 2603179 | 130 ACORN T700 RH USA | POWERED STAIRWAY CHAIR LIFT | PCD | ACORN STAIRLIFTS, INC. | 130 T700 RH |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 76 YR | Female | Other| R |