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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: PENNER MANUFACTURING, INC. CASCADE TRANSFER LIFT

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PENNER MANUFACTURING, INC. CASCADE TRANSFER LIFT Back to Search Results
Model Number 383000-1L
Device Problems Labelling, Instructions for Use or Training Problem; Inadequate or Insufficient Training; Device Handling Problem
Event Date 04/17/2015
Event Type  Injury  
Manufacturer Narrative

Device was inspected on 04/24/2015 and found to be in good condition. Interviews were conducted along with in house training on lift transfer. Employees were trained to use the brakes and all supplied belts during use with residents. Prior to inspection additional safety belts were ordered and rec'd by facility. Both the maintenance supervisor and the director of nursing both said that they believed that the belts were not being used at the time of the incident. It was also discussed that because of the size of the resident that more than one cna should be helping because one isn't enough to help just due to the size of a (b)(6) pound resident and the cna who is just over 5' and just over 100 pounds.

 
Event Description

Resident had just been given a bath and was taken out of the tub by the cna and resident went to reach for a towel to help cna dry him off and resident fell forward out of transfer and hit head on floor of bathing room. Resident was taken to the emergency room and evaluated. It was discovered that the resident had a concussion and a black eye.

 
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Brand NameCASCADE TRANSFER LIFT
Type of DeviceCASCADE TRANSFER LIFT
Manufacturer (Section D)
PENNER MANUFACTURING, INC.
Manufacturer Contact
patrick wall
101 grant st
aurora , NE 68818
4026945003
MDR Report Key4990447
Report Number1922538-2015-00001
Device Sequence Number1
Product CodeFNG
Report Source Manufacturer
Source Type COMPANY REPRESENTATIVE
Reporter Occupation NOT APPLICABLE
Remedial Action Inspection
Type of Report Initial
Report Date 08/03/2015
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received08/03/2015
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator HEALTH PROFESSIONAL
Device MODEL Number383000-1L
Was Device Available For Evaluation? Yes
Is The Reporter A Health Professional? No
Was the Report Sent to FDA? No
Distributor Facility Aware Date04/20/2015
Device Age2 yr
Event Location Nursing Home
Date Manufacturer Received04/20/2015
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured06/01/2013
Is The Device Single Use? No
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse

Patient TREATMENT DATA
Date Received: 08/03/2015 Patient Sequence Number: 1
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