BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PAL

    MDR report key: 485889 · Received September 24, 2003

    Report

    Report Number
    2132280-2003-00007
    Event Type
    Injury
    Date Received
    September 24, 2003
    Date of Event
    September 11, 2003
    Report Date
    September 16, 2003
    Manufacturer
    SUNRISE MACHINE AND TOOL, INC.
    Product Code
    FSA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS BEING LIFTED USING THE HOYER LIFT WHEN THE METAL HOOK (LEFT SIDE FACING HOYER) HOLDING THE SLING BROKE OFF. WHEN THE HOOK BROKE RESIDENT TIPPED TO LEFT SIDE, HEAD WENT BACK AND BUMPED BAR OF HOYER, BODY TURNED & RESIDENT FELL BACK TO FLOOR HEAD FIRST. BACK OF HEAD HIT THE FLOOR FROM HEIGHT OF 2 FEET. CNA THEN LOWERED RESIDENT TO THE FLOOR. RESIDENT WAS SENT TO E.R. FOR EVAL AND RETURNED TO NURSING HOME THAT EVENING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PAL HOYER LIFT - FULL BODY LIFT FSA SUNRISE MACHINE AND TOOL, INC. PL2505R UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Hospitalization