BEUDAMED
    FDA Adverse Event Injury Summary report: N

    T.H.E. MEDICAL

    MDR report key: 3527671 · Received December 16, 2013

    Report

    Report Number
    MW5033494
    Event Type
    Injury
    Date Received
    December 16, 2013
    Date of Event
    December 11, 2013
    Report Date
    December 13, 2013
    Manufacturer
    TOLLOS
    Product Code
    FNG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    STAFF MEMBER TOOK THE CEILING LIFT FROM THE CHARGING STATION IN THE BATHROOM, AND BROUGHT IT THROUGH THE FIRST CIRCULAR GATE AND CONTINUED TO WALK TOWARDS THE PT WITH THE LIFT AND THE MOTOR DROPPED OFF THE END OF THE TRACK, THE STAFF MEMBER AND THE PT WERE NOT INJURED. NO PT WAS IN THE LIFT AT THE TIME. PLEASE NOTE: THIS INCIDENT DID NOT OCCUR ON AN ACTUAL PT, THE AGE, DATE OF BIRTH AND WEIGHT THAT WERE GIVEN ABOVE WERE PLACEHOLDERS BECAUSE THIS WRITER HAD TO ENTER SOMETHING IN ORDER TO PROCEED WITH MY NOTIFICATION TO YOUR DEPARTMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    655759 T.H.E. MEDICAL CEILING LIFT FNG TOLLOS 600 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Required Intervention