BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EZ WAY

    MDR report key: 316134 · Received February 13, 2001

    Report

    Report Number
    MW1021075
    Event Type
    Malfunction
    Date Received
    February 13, 2001
    Date of Event
    February 1, 2001
    Report Date
    February 5, 2001
    Manufacturer
    EZ WAY INC.
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WI, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    WHILE STAFF WAS TRANSFERRING RESIDENT USING STAND LIFT, PLASTIC CLIP BELT ON EZ STAND HARNESS BROKE AND RESIDENT FELL TO THE FLOOR. RESIDENT WAS CLOSELY MONITORED, BUT SUSTAINED NO INJURIES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    5512 EZ WAY EZ STAND HARNESS FSA EZ WAY INC. 50-910 *

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR Other