BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    EZ WAY SMART LIFT

    MDR report key: 3561930 · Received January 3, 2014

    Report

    Report Number
    MW5033752
    Event Type
    Malfunction
    Date Received
    January 3, 2014
    Date of Event
    December 20, 2013
    Manufacturer
    EZ WAY, INC
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING TWO PERSON EZ WAY LIFT OF (B)(4) ON (B)(6) 2013, EZ WAY LIFT BROKE AT POINT OF WELD ON CROSS-BARS. RESIDENT WAS SAFELY LOWERED BACK TO GROUND AS HE WAS BEING LIFTED FROM THE FLOOR. EZ WAY LIFT HAD RUSTED AT POINT OF WELDING. LIFT WAS NEW WHEN PUT INTO USE IN (B)(6) 2013 AND HAD 551 USES AT TIME OF INCIDENT. DEVICE HAS BEEN REMOVED FROM SERVICE. DATES OF USE: (B)(6) 2013.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    4189 EZ WAY SMART LIFT EZ LIFT FSA EZ WAY, INC L600PN

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR