MAUDE Adverse Event Report: DRIVE MEDICAL/DEVILBISS PATIENT LIFT

Model Number 13023SV

Device Problems Detachment Of Device Component (1104); Component Falling (1105); Device Slipped (1584)

Patient Problem Injury (2348)

Event Date 05/05/2016

Event Type  Injury  

Event Description

A bolt that secured the lift pump handle loosened and fell off.The patient was in the sling and lift could not be lowered.Patient plus aide slid to the floor.Equipment was locked in upright position.Patient was injured and emergency personnel responded.Patient was subsequently hospitalized.

• Brand Name: PATIENT LIFT
• Type of Device: PATIENT LIFT
• Manufacturer (Section D): DRIVE MEDICAL/DEVILBISS
• MDR Report Key: 5684517
• MDR Text Key: 46183056
• Report Number: MW5062510
• Device Sequence Number: 1
• Product Code: FSA
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Voluntary
• Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date: 05/16/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/24/2016
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Model Number: 13023SV
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/12/2016
• Is the Reporter a Health Professional?: Yes
• Type of Device Usage: N
• Patient Sequence Number: 1
• Patient Age: 70 YR