BEUDAMED
    FDA Adverse Event Injury Summary report: N

    EZ WAY INC

    MDR report key: 5124744 · Received July 23, 2004

    Report

    Report Number
    5124744
    Event Type
    Injury
    Date Received
    July 23, 2004
    Date of Event
    July 9, 2004
    Report Date
    July 22, 2004
    Manufacturer
    EX WAY INC.
    Product Code
    FSA
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS TRANSFERRED INTO W/C WITH HOYER LIFT, LEG IMMOBILIZER ON (R) LEG. TWO STAFF ASSISTED WITH STAFF SUPPORTING LEG. PER NA-R REPORTS, RESIDENT C/O PAIN, STATED "FELT SOMETHING SNAP." MOVING SLOWLY IN HOYER, NO BUMPS, ABNORMALITIES OBSERVED BY NURSE WHEN LEG IMMOBILIZER APPLIED AT 6:15 AM. C/O PAIN WITH A.M. CARES WHILE ROLLING BACK AND FORTH FOR CARES FOR DRSG.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EZ WAY INC TOTAL LIFT FSA EX WAY INC. 796

    Patients

    Seq Age Sex Outcome Treatment
    1 83 YR Required Intervention