MAUDE MDR 6592602

MDR report key
6592602
Report number
1419181-2017-00003
Event key
0
Event type
3
Date of event
2017-04-25
Date received
2017-05-25
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
2
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. HEATHER SIRIANNI
Address
3909 THREE OAKS ROAD CARY IL 60013 US
Phone
815-815-8154
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PREVALON AIRTAP PATIENT REPOSITIONING SYSTEMPATIENT REPOSITIONING SYSTEMSAGE PRODUCTS LLCKME72117211UNKNOWNR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-05-2501. O

Event Narratives#

N

Patient 1

REPORTER DID NOT PROVIDE INVOLVED PRODUCT, PHOTOGRAPHS, OR LOT INFORMATION. PRODUCTION HISTORY RECORDS COULD NOT BE REVIEWED. PER THE INSTRUCTION FOR USE FOR THE PRODUCT, IT STATES ON PAGE 2, "ALWAYS FOLLOW YOUR FACILITY'S SAFE PATIENT HANDLING POLICIES AND PROCEDURES". ADDITIONALLY, ON PAGE 8 OF THE INSTRUCTIONS FOR USE, IT STATES, "EXTERIOR BED RAILS ON BOTH SURFACES SHOULD BE RAISED PRIOR TO TRANSFER TO PREVENT THE PATIENT FROM FALLING. IF THERE ARE NO BED RAILS USED, THE CAREGIVERS ARE RESPONSIBLE FOR MAKING SURE THE PATIENT DOES NOT REACH OUTSIDE THE BOUNDARIES OF EITHER SUPPORT SURFACE." THE ROOT CAUSE FOR THE REPORTED ISSUE COULD NOT BE DETERMINED. BASED ON THE LACK OF INFORMATION AND PRODUCT FOR EVALUATION, THERE IS INSUFFICIENT EVIDENCE TO CONCLUDE THAT THE REPORTED ISSUE WAS ATTRIBUTABLE TO A PRODUCT DEFECT OR MANUFACTURING OPERATIONS. CUSTOMER DECLINED TO RELEASE.

D

Patient 1

REPORT RECEIVED OF PATIENT FALL WITH POSSIBLE INJURY WHILE PRODUCT IN USE. INFORMATION OBTAINED BY MANUFACTURER SALES REPRESENTATIVE, WHO SPOKE TO USER FACILITY DIRECTOR OF NURSING CRITICAL CARE SERVICES AND SUPERVISOR OF RADIOLOGY. THE FOLLOWING INFORMATION WAS PROVIDED: ON (B)(6) 2017, A PATIENT WAS LATERALLY TRANSFERRED FROM THE BED TO THE RADIOLOGY TABLE, WHICH HAS A WIDTH OF TWENTY-FOUR INCHES. TWO RADIOLOGY TECHNICIANS ASSISTED IN THE TRANSFER. UPON LATERALLY TRANSFERRING THE PATIENT TO THE RADIOLOGY TABLE, THE PRODUCT'S AIR-ASSIST TECHNOLOGY WAS TURNED OFF. PER THE RADIOLOGY TECHNICIAN, THE PRODUCT DEFLATED UNEVENLY RESULTING IN THE PATIENT ROLLING OFF THE RADIOLOGY TABLE AND ON TO THE FLOOR. THE INITIAL USER FACILITY CONTACT INDICATED THAT THE PATIENT POSSIBLY SUSTAINED A HIP FRACTURE; HOWEVER, UPON SUBSEQUENT ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION, THE USER FACILITY DECLINED TO CONFIRM REPORT OR PROVIDE CLARIFICATION. ALTHOUGH REQUESTED, THE USER FACILITY DECLINED TO PROVIDE ADDITIONAL INFORMATION.