BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TOLLOS

    MDR report key: 6940452 · Received October 11, 2017

    Report

    Report Number
    MW5072705
    Event Type
    Injury
    Date Received
    October 11, 2017
    Date of Event
    October 8, 2017
    Report Date
    October 9, 2017
    Manufacturer
    TOLLOS
    Product Code
    FSA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OR, US
    Reporter Occupation
    PATIENT FAMILY MEMBER OR FRIEND

    Narratives

    Description of Event or Problem · 1

    CEILING STRAP TO THE LIFT BROKE CAUSING THE PT TO FALL BACK INTO BED AND THE LIFT BAR FELL ON THE PT. THE PT WAS NOT INJURED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    719516 TOLLOS LIFT, PATIENT, NON-AC POWERED FSA TOLLOS PINNACLE

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention