FDA Adverse Event Malfunction Summary report: N

DAYTON LINEAR ACTUATOR

MDR report key: 1825 · Received November 17, 1992

Report

Report Number
1825
Event Type
Malfunction
Date Received
November 17, 1992
Date of Event
October 25, 1992
Report Date
October 30, 1992
Manufacturer
MIDMARK CORPORATION SUPLLIED; DAYTON ELECTRIC MFG. CO.
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

PATIENT WAS IN BED, HUSBAND IN RECLINER BY BED, AND NURSE AT HEAD OF BED OBTAINING INFORMATION FROM THE PATIENT WHEN THE CHIK LIGHT FELL FROM THE CEILING TO A MIDWAY POSITION IN A SUDDEN MOTION WITHOUT ANY STIMULATION. FORTUNATELY NO ONE WAS INJURED. THE ACTUATOR WAS HANGING BY WIRES. THE METAL ATTACHMENT TO THE CEILING HAD RIPPED THE METAL. ENCLOSED IS A PICTURE FOR BETTER UNDERSTANDING. MIDMARK WAS NOTIFIED; THEY HAVE RETRIEVED THE ACTUATOR. THEY ALSO CHECKED ALL OUR SIMILAR LIGHTS IN L & D. WE WILL BE SUPPLIED WITH AN EXPLANATION AFTER EVALUATIONDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS MULTIPLE PATIENT INVOLVEMENT. NUMBER OF PATIENTS INVOLVED: 3.DEVICE NOT SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: NONE OR UNKNOWN, NONE OR UNKNOWN, UNANTICIPATED, OTHER. CONCLUSION: DEVICE FAILURE DIRECTLY CAUSED EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE RETURNED TO MANUFACTURER/DEALER/DISTRIBUTOR. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 DAYTON LINEAR ACTUATOR MOTOR TO CHIK LAMP MIDMARK CORPORATION SUPLLIED; DAYTON ELECTRIC MFG. CO. 4Z848 N/A

Patients

Seq Age Sex Outcome Treatment
1 30 YR Other