BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    NON AC-POWERED PATIENT LIFT

    MDR report key: 3024345 · Received March 27, 2013

    Report

    Report Number
    1525712-2013-02376
    Event Type
    Malfunction
    Date Received
    March 27, 2013
    Report Date
    March 1, 2013
    Manufacturer
    UNKNOWN
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    (B)(4). INJURY ALLEGED. MALFUNCTION ALLEGED. FACILITY REPRESENTATIVE STATED THAT PATIENT'S HUSBAND PUT HER IN THE LIFT AND THEN ROLLED THE PATIENT LIFT TO THE BATHROOM. ENROUTE TO THE BATHROOM, ONE OF THE BOLTS ON THE LEFT REAR WHEEL STRIPPED OUT AND BENT. AT THAT TIME THE PATIENT TOPPLED OVER WITH THE LIFT AND HIT THE GROUND. THE LIFT LANDED ON TOP OF HER. MEDICAL INTERVENTION UNKNOWN. MDR FILED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    126137 NON AC-POWERED PATIENT LIFT 880.5510 FSA UNKNOWN 9805

    Patients

    Seq Age Sex Outcome Treatment
    1 Other