SARA 3000

MDR report key: 1971752 · Received January 12, 2011

Report

Report Number: 3004468271-2011-00003
Event Type: Malfunction
Date Received: January 12, 2011
Date of Event: December 29, 2010
Report Date: January 7, 2011
Manufacturer: MEDIBO MEDICAL PRODUCTS NV
Product Code: FSA
Product Problem: Yes
Report Source: Manufacturer report
Reporter Location: CO, US
Reporter Occupation: NOT APPLICABLE

Narratives

Additional Manufacturer Narrative · 1

ADDITIONAL INFO WILL BE PROVIDED FOLLOWING THE CONCLUSION OF THE MFR'S INVESTIGATION.

Description of Event or Problem · 1

LIFT WAS BEING USED BY AN AID WHO THE FACILITY MAINTENANCE MGR HAS NOT BEEN ABLE TO IDENTIFY AT THIS TIME. HE WAS TOLD THAT THE LIFT WAS BEING USED AND SOMEONE SMELLED SMOKE SO IT WAS DISCONTINUED. NO KNOWLEDGE OF WHETHER A RESIDENT WAS IN THE LIFT OR NOT. THE BATTERY HAS A LITTLE BUBBLE ON THE LABEL SIDE; NO DISCOLORATION OTHERWISE. THE LIFT HAS NO DISCOLORATION BUT THE LIFTING ARM IS STUCK IN THE FAR NORTH POSITION.

Devices

Seq	Brand	Generic	Product Code	Manufacturer	Model	Lot	UDI-DI
1	SARA 3000	ACTIVE FLOOR LIFT	FSA	MEDIBO MEDICAL PRODUCTS NV

Patients

Seq	Age	Sex	Outcome	Treatment
1			Other