MAUDE Adverse Event Report: INVACARE SUZHOU NON AC-POWERED PATIENT LIFT; 880.5510

Model Number 9805P

Device Problems Break (1069); Component Falling (1105); Hole In Material (1293)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 01/22/2014

Event Type  malfunction  

Event Description

It was reported that the pin on a lift pump handle fell out due to a stripped hole.There was no report of user injury or medical intervention.

• Brand Name: NON AC-POWERED PATIENT LIFT
• Type of Device: 880.5510
• Manufacturer (Section D): INVACARE SUZHOU; unit 28 zone,200 suhong rd; suzhou industrial park; jiangsu, p.r.c. 2150 21; CH 215021
• Manufacturer (Section G): INVACARE SUZHOU; unit 28 zone,200 suhong rd; suzhou industrial park; jiangsu, p.r.c. 2150 21; CH 215021
• Manufacturer Contact: patricia medina ; one invacare way; elyria, OH 44035 ; 8003336900
• MDR Report Key: 3598316
• MDR Text Key: 19695102
• Report Number: 3004493922-2014-00159
• Device Sequence Number: 1
• Product Code: FSA
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Distributor
• Reporter Occupation: Medical Equipment Company Technician/Representative
• Type of Report: Initial
• Report Date: 01/22/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/29/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: 9805P
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 01/22/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1
• Patient Outcome(s): Other