MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,06 report with the FDA on 2005-03-04 for V4 4FB QUIKTRAK 9100001 NA manufactured by Bhm Medical, Inc..
[21628041]
Two parts of the track system suddenly separated and the ceiling lift fell on the floor. The spreader bar hit the resident on the forehead and caused a small bruise on forehead.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9681684-2005-00001 |
| MDR Report Key | 580983 |
| Report Source | 01,06 |
| Date Received | 2005-03-04 |
| Date of Report | 2005-02-14 |
| Date of Event | 2005-01-30 |
| Date Mfgr Received | 2005-02-01 |
| Device Manufacturer Date | 2003-01-01 |
| Date Added to Maude | 2005-03-15 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Manufacturer Contact | TRACI GIOVENCO |
| Manufacturer Street | 50 N. GARY AVE STE A |
| Manufacturer City | ROSELLE IL 50172 |
| Manufacturer Country | US |
| Manufacturer Postal | 50172 |
| Manufacturer Phone | 6303076140 |
| Manufacturer G1 | BHM MEDICAL INC. |
| Manufacturer Street | * |
| Manufacturer City | MAGOG, QC |
| Manufacturer Country | CA |
| Single Use | 3 |
| Remedial Action | RP |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | V4 4FB QUIKTRAK |
| Generic Name | CEILING LIFT |
| Product Code | KNG |
| Date Received | 2005-03-04 |
| Model Number | 9100001 |
| Catalog Number | NA |
| Lot Number | NA |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 570823 |
| Manufacturer | BHM MEDICAL, INC. |
| Manufacturer Address | 2001 TANGUAY ST. MAGOG, QUEBEC CA |
| Baseline Brand Name | V4 4FB QUIKTRAK |
| Baseline Generic Name | CEILING LIFT |
| Baseline Model No | 9100001 |
| Baseline Catalog No | NA |
| Baseline ID | NA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2005-03-04 |