BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EZ LIFT MECHANICAL LIFT

    MDR report key: 324159 · Received March 27, 2001

    Report

    Report Number
    324159
    Event Type
    Malfunction
    Date Received
    March 27, 2001
    Date of Event
    March 5, 2001
    Report Date
    March 22, 2001
    Manufacturer
    EZ WAY INC
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    NURSE AND NURSING ASSISTANT WERE TRANSFERRING RESIDENT WITH EZ LIFT. RESIDENT WAS IN BED TRANSFERRING TO WHEELCHAIR. RESIDENT WAS IN MIDAIR WHEN BASE OF THE LIFT BROKE. RESIDENT FELL ONTO BACK AND STRUCK BACK OF HEAD OF LIFT. RESIDENT WAS ASSISTED BACK TO BED. RESIDENT HAD COMPLAINTS OF HEADACHE AND HIP, BACK AND LEG PAIN. X-RAYS TAKEN AND CT SCAN OF HEAD TAKEN. MONTHLY MAINTENANCE OF LIFT COMPLETED WITH NO NOTED ABNORMALITIES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    13629 EZ LIFT MECHANICAL LIFT MECHANICAL PT LIFT FSA EZ WAY INC NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR Other