BEUDAMED
    FDA Adverse Event Other Summary report: N

    VANDERLIFT

    MDR report key: 956411 · Received November 28, 2007

    Report

    Report Number
    1933441-2007-00005
    Event Type
    Other
    Date Received
    November 28, 2007
    Date of Event
    November 3, 2007
    Report Date
    November 27, 2007
    Manufacturer
    VANCARE, INC.
    Product Code
    FNG
    Report Source
    Manufacturer report
    Reporter Location
    AR, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    ACTUATOR BEING RETURNED TO VANCARE INC. FOR INSPECTION. DISTRIBUTOR TOOK REPLACEMENT LIFT TO FACILITY FOR USE WHILE EVAL IS BEING CONDUCTED. ACTUATOR RETURNED TO VANCARE, INC 11/26/207. VANCARE INC WILL SEND TO MFR FOR THEIR EVAL, ACTUATOR SENT TO THEM ON 11/27/2007.

    Description of Event or Problem · 1

    PT BEING TRANSFERRED FROM WHEEL CHAIR TO BED. ACTUATOR ON LIFT BROKE AND CAUSED PT TO FALL. PT NOT INJURED, NO BRUISING OBSERVED AT TIME OF ACCIDENT. ACTUATOR WILL BE RETURNED TO VANCARE AND WE WILL SEND TO MFR FOR EVAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VANDERLIFT VANDERLIFT PATIENT LIFT FNG VANCARE, INC. B450

    Patients

    Seq Age Sex Outcome Treatment
    1 YR