BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ARJO HUNTLEIGH

    MDR report key: 1696446 · Received May 14, 2010

    Report

    Report Number
    MW5016010
    Event Type
    Malfunction
    Date Received
    May 14, 2010
    Date of Event
    May 13, 2010
    Report Date
    May 13, 2010
    Manufacturer
    ARJO-CENTURY, INC.
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    AK, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PLASTIC CONNECTOR ON ARJO LIFT SLING BROKE IN HALF AND RESIDENT FELL TO THE FLOOR. THIS OCCURRED WHILE BEING TRANSFERRED FROM BED TO CHAIR. DATES OF USE: (B) (6) 5/04. DIAGNOSIS OR REASON FOR USE: DEMENTIA. EVENT ABATED AFTER USE STOPPED: YES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ARJO HUNTLEIGH LIFT SLING FSA ARJO-CENTURY, INC. MAA4000XL NA

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other