BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AC-POWERED ADJUSTABLE HOSPITAL BED, INCLUDING RAILS

    MDR report key: 2427206 · Received January 25, 2012

    Report

    Report Number
    3003433498-2012-00004
    Event Type
    Malfunction
    Date Received
    January 25, 2012
    Report Date
    January 24, 2012
    Manufacturer
    CARROLL HEALTHCARE
    Product Code
    FNL
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    RMA 859789784 HAS BEEN INITIATED FOR THIS ISSUE. MODEL BC1180-111-AE, SERIAL NUMBER/DATE CODE (B)(4). THE USER MANUAL PART NUMBER 1153410 WAS ISSUED WITH THIS DEVICE. THE USER MANUAL IS ALSO FOUND ON-LINE AT INVACARE.COM. IT IS UNKNOWN IF THE CONSUMER HAS FULLY READ AND UNDERSTANDS THE USER MANUAL. DOCUMENTATION PROVIDES WARNINGS, CAUTIONS, AND INSTRUCTIONS FOR SAFELY USING THE DEVICE. IF THE CONSUMER DOES NOT UNDERSTAND THE WRITTEN WARNINGS, CAUTIONS OR INSTRUCTIONS THEN THEY SHOULD CONTACT INVACARE. THE CONSUMERS MEDICAL CONDITION, STABILITY AND MEDICATION REGIMEN ARE UNKNOWN. THE CONSUMERS AGE, HEIGHT AND WEIGHT ARE UNKNOWN. THE CONSUMERS TECHNIQUE WHILE USING THE DEVICE IS UNKNOWN. THE MAINTENANCE HISTORY OF THE DEVICE IS UNKNOWN.

    Description of Event or Problem · 1

    DEALER WAS REPLACING A J-BOX ON CARROLL HOMECARE BED SERIAL #(B)(4) UNDER WARRANTY (B)(4) AND ALLEGES WHEN HE PLUGGED IN THE HI-LO MOTOR TO THE NEW J-BOX THAT THE HI-LO MOTOR SPARKED AND SMOKE CAME OUT OF IT. NO INJURY IS ALLEGED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AC-POWERED ADJUSTABLE HOSPITAL BED, INCLUDING RAILS 880.5100 FNL CARROLL HEALTHCARE BC1180-111-AE

    Patients

    Seq Age Sex Outcome Treatment
    1 Other