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Per caregiver, the child broke the safety sheet zipper and the padlock during the night leading to the child eloping out from under the bed.Per caregiver, the child removed the safety sheet zipper tab.Per caregiver, based on their visual assessment, the child chewed on the teeth of the safety sheet as well as the padlock.Per caregiver, the child received scrapes from the elopement which did not require medical attention.
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Sensory medical requested return for examination of the damaged safety sheet.The product has not been returned for evaluation as of the writing of this investigation.Sensory medical provided a replacement safety sheet.250614m14 is the lot for the safety sheet.Review of manufacturing records confirmed all in process and final inspections passed.017157 is the lot for the padlock.Review of manufacturing records confirmed all in process and final inspections passed.Multiple statements are made in the cubby bed user manual regarding safe use of the bed to prevent elopement and other safety concerns.Page 3 of the cubby bed user manual contains a warning for entrapment hazard."to avoid dangerous gaps do not use this product without the safety sheets completely zipped and locked in place to the sidewall.Safety sheet with lock in place is always required."" page 5 contains a parts list, which includes the locks.Page 11 instructs to secure the safety sheet zipper to the loop on the canopy with the lock to prevent the patient user from removing the sheet.Do not use the product without the safety sheets zipped and locked in place.Page 15 assembly + care faq's includes description and use of the locks on the safety sheets and the technology hub zippers.Page 22 includes a monthly maintenance checklist, one check is: "safety sheet fabric, cord loop and zippers have no tears, rips or snags and lock is secured." page 22 of the user manual, maintenance checklist, describes discontinuing use of the bed if anything is damaged or missing.Additional investigation is needed, and sensory medical's root cause investigation is ongoing.
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