BEUDAMED
    FDA Adverse Event Injury Summary report: N

    130 ACORN T700 RH USA

    MDR report key: 15198399 · Received August 10, 2022

    Report

    Report Number
    3003124453-2022-00009
    Event Type
    Injury
    Date Received
    August 10, 2022
    Date of Event
    July 11, 2022
    Report Date
    August 8, 2022
    Manufacturer
    ACORN STAIRLIFTS, INC.
    Product Code
    PCD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    003

    Narratives

    Description of Event or Problem · 0

    ON (B)(6) 2022, ACORN STAIRLIFTS, INC. WAS CONTACTED BY THE USER TO REQUEST SERVICE FOR THE STAIRLIFT DUE TO THE STAIRLIFT NOT OPERATING. THE REPORT WAS THAT THERE WAS AN H5 (MEMORY NOT RESPONDING) CODE. A SERVICE TICKET WAS INITIATED FOR THE SCHEDULING TEAM TO SCHEDULE SERVICE BECAUSE ACORN WAS NOT ABLE TO SCHEDULE SERVICE ON (B)(6) 2022. ON (B)(6) 2022, THE USER CONTACTED ACORN TO INQUIRE ABOUT THE SCHEDULED SERVICE DATE. HE COMMUNICATED TO ACORN THAT SINCE THE DATE THAT HE FIRST CONTACTED ACORN, HE HAD USED THE STAIRS AND HE HAD FALLEN DOWN THE STAIRS RESULTING IN A BROKEN LEFT WRIST AND HEAD CONTUSIONS. THE USER WAS NOT ABLE TO RECALL THE EXACT DATE OF THE INCIDENT BUT THAT IT DID OCCUR BETWEEN (B)(6) 2022.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    373702 130 ACORN T700 RH USA POWERED STAIRWAY CHAIR LIFT PCD ACORN STAIRLIFTS, INC. 130 T700

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR Male Other| R