BEUDAMED
    FDA Adverse Event Death Summary report: N

    EZ LIFT SIT-TO-STAND

    MDR report key: 6983138 · Received October 27, 2017

    Report

    Report Number
    MW5072972
    Event Type
    Death
    Date Received
    October 27, 2017
    Date of Event
    February 17, 2017
    Report Date
    October 20, 2017
    Manufacturer
    EZ WAY, INC.
    Product Code
    FSA
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MY FATHER, A RESIDENT OF (B)(6), WAS BEING PREPPED FOR BED. THE EZ LIFT SIT-TO-STAND BEING USED BY ONE CNA PURPORTEDLY MALFUNCTIONED. THE ARMS DROPPED TO THE LOWEST LEVEL, CAUSING MY FATHER TO FALL TO HIS KNEES. HE WAS SUBSEQUENTLY FOUND TO HAVE TWO BROKEN FEMURS AND ALSO HAD A STENT DISTURBED THAT CAUSED BLOOD FLOW LOSS TO ONE OF HIS LEGS. HE HAD TO RETURN TO SURGERY TO TRY TO REPAIR THAT AND RESTORE A PULSE. HE DID NOT REGAIN CONSCIOUSNESS AND DIED AT THE FACILITY, (B)(6) ON (B)(6) 2017. PICTURE OF LIFT TAKEN (B)(6) 2017 NEAR DIRECTOR OF NURSING'S OFFICE. I WAS INFORMED THAT IT NEEDED TO BE INSPECTED, THAT THERE MUST BE A SHORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    764931 EZ LIFT SIT-TO-STAND EZ LIFT FSA EZ WAY, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 96 YR Death| H