BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    NON AC-POWERED PATIENT LIFT

    MDR report key: 4132199 · Received October 1, 2014

    Report

    Report Number
    1525712-2014-06570
    Event Type
    Malfunction
    Date Received
    October 1, 2014
    Date of Event
    September 10, 2014
    Report Date
    September 11, 2014
    Manufacturer
    UNKNOWN
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SC, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER ALLEGED THE SOCKET HEAD SCREW THAT HOLDS THE MAST IN THE BASE HAS COME OUT. THE MAST LIFTED OUT OF THE BASE AND TIPPED TO THE LEFT SIDE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    612080 NON AC-POWERED PATIENT LIFT 880.5510 FSA UNKNOWN 9805

    Patients

    Seq Age Sex Outcome Treatment
    1 Other