MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 1996-09-05 for VA 100 ULTRAGATER LIFT VA-100 NA manufactured by Aequitron Medical, Inc..
[18603536]
Report of alleged "platform dropped with user on it resulting in injuries to user. "
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2183157-1996-00001 |
| MDR Report Key | 38735 |
| Report Source | 07 |
| Date Received | 1996-09-05 |
| Date of Report | 1996-08-06 |
| Date of Event | 1996-08-06 |
| Date Facility Aware | 1996-08-06 |
| Report Date | 1996-08-06 |
| Date Reported to Mfgr | 1996-08-06 |
| Date Mfgr Received | 1996-08-06 |
| Device Manufacturer Date | 1995-02-01 |
| Date Added to Maude | 1996-09-20 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VA 100 ULTRAGATER LIFT |
| Generic Name | AUTOMATIC VAN LIFT |
| Product Code | ING |
| Date Received | 1996-09-05 |
| Model Number | VA-100 |
| Catalog Number | NA |
| Lot Number | NA |
| ID Number | NA |
| Device Availability | * |
| Device Age | 12 MO |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 39972 |
| Manufacturer | AEQUITRON MEDICAL, INC. |
| Manufacturer Address | 14800 28TH AVE NORTH PLYMOUTH MN 55447 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 1996-09-05 |