MAUDE Adverse Event Report: LIKO AB VIKING M; NON-AC POWERED PATIENT LIFT

Model Number 2040015

Device Problem Sparking (2595)

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

Event Date 05/28/2014

Event Type  malfunction  

Event Description

It was reported to hill-rom that the charger cable for mobile lift has almost broken off and sparks and burnt smell was noticed when the plug was pulled from the wall socket.No injury alleged.Mfr - 8030916-2014-00043.

• Brand Name: VIKING M
• Type of Device: NON-AC POWERED PATIENT LIFT
• Manufacturer (Section D): LIKO AB; nedre vagen 100; lulea 975 92; SW 975 92
• Manufacturer (Section G): HILL-ROM, INC.; 125 east pearl st.; batesville IN 47006
• Manufacturer Contact: 125 east pearl st.; batesville, IN 47006
• MDR Report Key: 3913225
• MDR Text Key: 21488909
• Report Number: 1824206-2014-01812
• Device Sequence Number: 1
• Product Code: FSA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Distributor
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 06/20/2014,05/28/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 2040015
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: Yes
• Date Report Sent to FDA: 06/20/2014
• Distributor Facility Aware Date: 05/28/2014
• Device Age: 6 YR
• Date Report to Manufacturer: 06/20/2014
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 06/20/2014
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1