BEUDAMED
    FDA Adverse Event Death Summary report: N

    MAXILIFT

    MDR report key: 824725 · Received March 6, 2007

    Report

    Report Number
    MW1042105
    Event Type
    Death
    Date Received
    March 6, 2007
    Manufacturer
    ARJO CENTURY, INC.
    Product Code
    FSA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THIS INDIVIDUAL WAS BEING TRANSFERRED FROM WHEELCHAIR TO HER BED. WHILE SUSPENDED IN THE AIR BY THE LIFT, THE LIFT ARM & HANDLE SEPARATED FROM THE LIFT CAUSING THAT PART AND THE RESIDENT TO FALL APPROXIMATELY 4 FEET TO THE FLOOR. THE INJURED INDIVIDUAL WAS SENT BY AMBULANCE TO THE LOCAL HOSPITAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MAXILIFT MAXILIFT FSA ARJO CENTURY, INC. 212000-06 *

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Death