BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ACORN 180 T565

    MDR report key: 16119363 · Received January 8, 2023

    Report

    Report Number
    3003124453-2023-00002
    Event Type
    Injury
    Date Received
    January 8, 2023
    Date of Event
    December 11, 2022
    Report Date
    January 7, 2023
    Manufacturer
    ACORN STAIRLIFTS, INC.
    Product Code
    PCD
    PMA / PMN Number
    N/A#S-P#N/A
    Removal / Correction Number
    N/A
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    INCIDENT INVESTIGATION REPORT. WORK COMPLETION REPORT.

    Description of Event or Problem · 0

    CLIENT CONTACTED ACORN STAIRLIFTS, INC. (ACORN) ON (B)(6) 2022. THE CLIENT COMMUNICATED THAT HER HUSBAND WAS WALKING UP THE STAIRS AND HAD FALLEN ON (B)(6) 2022 RESULTING IN THREE BROKEN RIBS ON HIS LEFT SIDE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1392462 ACORN 180 T565 POWERED STAIRWAY CHAIR LIFT PCD ACORN STAIRLIFTS, INC. 180 T565 RH USA

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Male Other