BEUDAMED
    FDA Adverse Event Other Summary report: N

    VANDERLIFT

    MDR report key: 835200 · Received April 4, 2007

    Report

    Report Number
    MW1042473
    Event Type
    Other
    Date Received
    April 4, 2007
    Date of Event
    March 13, 2007
    Report Date
    March 28, 2007
    Manufacturer
    VANCARE INC.
    Product Code
    FSA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    RESIDENT WAS BEING TRANSFERRED FROM A CHAIR TO HIS BED USING A VANDERLIFT. THE RESIDENT WAS OVER HIS BED (APPROXIMATELY 12 INCHES HIGH) WHEN THE VANDERLIFT FRAME AT THE BASE FAILED, CAUSING THE RESIDENT TO FALL. NO INJURIES, HOWEVER, IT KNOCKED THE BREATH OUT OF THE RESIDENT. THE LIFT BASE HAS TUBE IRON (APPROXIMATELY 1.5 X 3.0 INCHES) WELDED TO A METAL PLATE. THE WELD DID NOT BREAK, HOWEVER, ABOVE THE WELD THE TUBE IRON PULLED APART. THIS LIFT WAS PURCHASED 06/01/1995 AND PREVENTATIVE MAINTENANCE IS COMPLETED AS RECOMMENDED BY THE MANUFACTURER. THE LIFT IS RATED FOR 600 LBS. THE NEWER VANDERLIFT MODELS HAVE A REINFORCED METAL PIECE WELDED IN THE SAME LOCATION WHERE THE OLDER LIFT FAILED. DISTRIBUTOR WAS CONTACTED AND VISITED ON 03/19/2007 TO INVESTIGATE. AT THIS TIME, PRESIDENT TOOK THE BASE AND BOOM ASSEMBLY WITH HIM FOR ANALYSIS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VANDERLIFT RESIDENT LIFT FSA VANCARE INC. 310-4043 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Other