MAUDE MDR 1481982

MDR report key
1481982
Report number
1022819-2009-00165
Event key
0
Event type
3
Date of event
2009-06-24
Date received
2009-07-22
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MICHAEL TREAS
Address
4717 ADAMS RD. HIXSON TN 37343 US
Phone
423-423-4238
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ERGOSTYLE FXINQ58205820Y Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12009-07-220

Event Narratives#

D

Patient 1

ON THE 24TH OF JUNE A FEMALE PT (B)(6) WAS AT HER CHIROPRACTOR FOR THE TREATMENT OF BACK PAIN. WHEN ATTEMPTING TO POSITION HERSELF ON THE TABLE SHE PLACED HER HAND ON THE PELVIC SECTION FOR SUPPORT AND THE PELVIC SECTION PIVOTED CAUSING THE PT TO FALL TO THE GROUND HITTING HER ELBOW. PER THE ATTENDING HEALTHCARE PROFESSIONAL THE PT'S PROGRESS TOWARD RECOVERY WAS NOT IMPEDED AND MEDICAL TREATMENT FOR THE FALL WAS NOT REQUIRED.

N

Patient 1

REPAIR OF THE TABLE FOUND THE MECHLOK ON THE PELVIC SECTION HAD LOCKED-UP AND THE LIMIT SWITCH ASSOCIATED WITH THE PELVIC TILT WAS BROKEN. THIS COMPLAINT WAS REPORTED TWICE. THE FIRST COMPLAINT INVOLVED THE INCIDENT AND THE SECOND COMPLAINT STATED ONLY THAT THE PELVIC SECTION WAS LOCKED-UP. THE TABLE WAS RECEIVED BY OUR SERVICE DEPT ON THE SECOND COMPLAINT, REPAIRED AND RETURNED TO THE CUSTOMER. AFTER REPAIR FULL FUNCTIONAL TESTS WERE PERFORMED AND THE TABLE WAS INSPECTED BY A QUALITY ENGINEER BEFORE RETURNING THE TABLE TO THE CUSTOMER. A SIX MONTH REVIEW OF COMPLAINTS FOR THIS TABLE WAS EVALUATED. TEN OF THE COMPLAINTS INVOLVED FAILURE OF THE MECHLOK. THE MECHLOK IS EXPECTED TO FAIL WITH EXCESSIVE USE AND THE FAILURE RATE, BASED ON THE # OF COMPLAINTS IS APPROXIMATELY 55 PER MILLION TREATMENTS. THIS UNIQUE INCIDENT, IS OF LOW SEVERITY WITH A POTENTIAL FOR APPROXIMATELY 3 INCIDENTS PER MILLION TREATMENTS. PER THE INSTRUCTIONS FOR USE THE OCCURRENCE COULD BE MITIGATED IF THE WARNINGS, CAUTIONS AND DANGERS ARE FOLLOWED. THE TABLE SHOULD BE LOCKED BEFORE THE LOADING OR UNLOADING OF A PT AND THE CABLES AND CONNECTORS SHOULD BE INSPECTED PRIOR TO USE.