BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MAXI 500

    MDR report key: 3111221 · Received April 19, 2013

    Report

    Report Number
    1419652-2013-00100
    Event Type
    Malfunction
    Date Received
    April 19, 2013
    Report Date
    April 4, 2013
    Manufacturer
    ARJOHUNTLEIGH MAGOG INC.
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    VA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    WITH A FLOOR LIFT, CERTIFIED NURSING ASSISTANT (CNA) WAS TRANSFERRING A RESIDENT FROM BED TO CHAIR. CNA WERE CHECKED THE CONNECTIONS. THE LOWER LEFT SLING CLIP WAS DETACHED AND THE RESIDENT SLID OUT AND HIT THEIR HEAD. X-RAYS WAS TAKEN BUT NO INJURIES WERE REPORTED. MFR #: 9681684-2013-00037.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    168681 MAXI 500 MANUFACTURED FLOOR PASSIVE LIFT FSA ARJOHUNTLEIGH MAGOG INC. KM560181

    Patients

    Seq Age Sex Outcome Treatment
    1