MAUDE Adverse Event Report: STRYKER MEDICAL-KALAMAZOO ULTRA COMFORT, SE 4 X 30 W/FB; MATTRESS, FLOTATION THERAPY, NON-POWERED

Catalog Number 1704034301

Device Problem Detachment of Device or Device Component (2907)

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

Event Date 06/05/2018

Event Type  malfunction  

Event Description

It was reported that a transporter was moving a patient from the stretcher to the bed and the mattress detached from the stretcher.The patient was not adversely affected and no clinically relevant delay in treatment was reported.

Manufacturer Narrative

It was identified that the velcro on the litter did not line up with the mattress velcro.The issue was resolved for the customer by installing additional velcro pile.

Event Description

It was reported that a transporter was moving a patient from the stretcher to the bed and the mattress detached from the stretcher.The patient was not adversely affected and no clinically relevant delay in treatment was reported.

• Brand Name: ULTRA COMFORT, SE 4 X 30 W/FB
• Type of Device: MATTRESS, FLOTATION THERAPY, NON-POWERED
• Manufacturer (Section D): STRYKER MEDICAL-KALAMAZOO; 3800 east centre avenue; portage MI 49002
• Manufacturer (Section G): STRYKER MEDICAL-KALAMAZOO; 3800 east centre avenue; portage MI 49002
• Manufacturer Contact: brian thompson ; 3800 east centre avenue; portage, MI 49002 ; 2693292100
• MDR Report Key: 7672316
• MDR Text Key: 113640903
• Report Number: 0001831750-2018-00638
• Device Sequence Number: 1
• Product Code: IKY
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: user facility
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 08/30/2018

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: No Information
• Device Catalogue Number: 1704034301
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 06/12/2018
• Initial Date FDA Received: 07/09/2018
• Supplement Dates Manufacturer Received: 06/12/2018
• Supplement Dates FDA Received: 08/30/2018
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 05/17/2018
• 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