ALLEN

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2013-07-01 for ALLEN manufactured by Allen Medical Systems.

Event Text Entries

[3654238] Allen medical systems received a medwatch report (uf/importer report # (b)(4)) from fda which had been submitted in regard to an event reported to occur at winnie palmer hospital for women and babies, orlando fl. The following event was reported: when a yellowfin stirrup (right-hand side) was raised upon completion of a surgical procedure so that the operating room table foot section could be replaced onto the table, the stirrup and rail clamp detached from the table with the pt's leg secured to the stirrup. Operating room staff immediately took hold of the pt's leg to prevent injury. When the stirrup / rail clamp was reattached to the bed, it was noted that the clamp tightening knob was "very loose". The pt showed no sign of trauma or deformity. An x-ray image was taken and was normal. The event was not reported to allen medical by the user. The observation made by the user prior to reattaching the stirrup / clamp, that the tightening knob was noted to be very loose, indicates that user error is a probable cause of detachment of the stirrup as the knob should always be verified to be firmly tightened prior to the start of a procedure as specified in the instructions for use supplied with the device. Contact attempts with the customer have been initiated to request additional information and return of the device for evaluation if possible. A follow-up medwatch report will be submitted should any relevant investigatory results be obtained.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1221538-2013-00009
MDR Report Key3224529
Report Source06
Date Received2013-07-01
Date of Report2013-05-17
Date of Event2013-03-11
Date Mfgr Received2013-05-17
Date Added to Maude2013-07-18
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional0
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer StreetONE POST OFFICE SQUARE
Manufacturer CityACTON MA 01720
Manufacturer CountryUS
Manufacturer Postal01720
Manufacturer Phone8885214277
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameALLEN
Generic NameLITHOTOMY STIRRUP
Product CodeEYD
Date Received2013-07-01
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerALLEN MEDICAL SYSTEMS
Manufacturer AddressACTON MA US


Patients

Patient NumberTreatmentOutcomeDate
10 2013-07-01

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