BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDI-LIFT

    MDR report key: 3234047 · Received July 11, 2013

    Report

    Report Number
    1419652-2013-00195
    Event Type
    Malfunction
    Date Received
    July 11, 2013
    Date of Event
    June 27, 2013
    Report Date
    June 27, 2013
    Manufacturer
    ARJOHUNTLEIGH MAGOG INC
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    CA
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    TWO STAFF MEMBERS WERE LIFTING RESIDENT FROM BED TO CHAIR. RESIDENT SLIPPED OUT OF THE SLING, AND FELL TO THE FLOOR. MEDICAL ASSESSEMENT PERFORMED ON RESIDENT AND AMBULANCE TOOK RESIDENT TO HOSP. THE RESIDENT GOT A CUT ON HIS FOREHEAD. REF #9681684-2013-00062.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    320856 MEDI-LIFT FSA ARJOHUNTLEIGH MAGOG INC 87001001

    Patients

    Seq Age Sex Outcome Treatment
    1 100 YR