FDA Adverse Event Other Summary report: N

ALENTI

MDR report key: 1878549 · Received October 1, 2010

Report

Report Number
9611530-2010-00070
Event Type
Other
Date Received
October 1, 2010
Date of Event
September 17, 2010
Report Date
September 17, 2010
Manufacturer
ARJO HOSPITAL EQUIPMENT AB
Product Code
FSA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
GM
Reporter Occupation
NOT APPLICABLE

Narratives

Additional Manufacturer Narrative · 1

WE ARE REPORTING ACCORDING TO EXEMPTION NO (B)(4). INCIDENTS INVOLVING MEDICAL DEVICES MANUFACTURED BY ARJO HOSPITAL EQUIPMENT (B)(4) WILL BE REPORTED BY US, THE LEGAL MANUFACTURER, ARJO HOSPITAL EQUIPMENT (B)(4) ON BEHALF OF OUR SALES AND DISTRIBUTION COMPANY IN THE (B)(4), ARJO INC, (B)(4). ADDITIONAL INFORMATION WILL BE PROVIDED UPON CONCLUSION OF THE MANUFACTURER'S INVESTIGATION.

Description of Event or Problem · 1

AS STATED BY THE CUSTOMER ON (B)(6) 2010: "ALENTI WITH PT FELL OVER." (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ALENTI LIFT, PATIENT, NON-AC-POWERED FSA ARJO HOSPITAL EQUIPMENT AB CDB8001-01

Patients

Seq Age Sex Outcome Treatment
1 90 YR