WINCO 6740 6740-28-00-HM

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2018-12-31 for WINCO 6740 6740-28-00-HM manufactured by Winco Mfg., Llc.

Event Text Entries

[131727709] On (b)(6) 2016 winco mfg. , llc (customer service) was contacted by (b)(6), technical services operations coordinator. She informed us that an injury occured while a patient was using a swing-away arm designer care cliner, model 6740-28-00-hm, sn (b)(4). Ms. (b)(6) also informed us ((b)(6) 2016) that their risk manager would contact us regarding her investigation. Event description: as the patient was re-positioning himself in the dialysis chair, the arm unexpectedly swung open and he fell, fracturing his hip. He required hospitalization and hip surgery. There was no information given on the outcome of the patient's condition after treatment. On (b)(4) 2016 we spoke with (b)(6) - risk manager, (b)(6) - technical services operations coordinator and (b)(6) - technician. They were unable to duplicate the condition described and said the latch did not seem to function well. They admitted that the left arm needed to be lifted to close tightly and the gap is visibly uneven compared to the right side arm. They also stated that they did not know that they should not sit on or put weight on swing arms in the open position. Ms (b)(6) informed us to contact (b)(6) for further questions and for permission to pick up the chair for winco to evaluate. On 09/29/2016 the chair was returned to winco where engineering & quality performed an inspection on it. The hinge bolt was loose on the left swing arm causing the arm to droop down far enough that the stricker pin would not properly engage the latch. This condition would allow the arm to swing out unexpectedly. Lifting up the arm would allow the arm to latch properly. Most likely underlying cause was that hardware loosened due to frequent use and time and recommended maintenance was not being performed as pointed out in the user's manual. Also, there are indications that excessive weight was placed on opened swing arms causing the arm to droop. The chair should have also been removed from service as soon as this condition was noticed by staff in accordance with instructions in the user's manual. The swing arm hinge was bent and loose, however, latch assembly functioned properly.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1027229-2018-00001
MDR Report Key8206399
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2018-12-31
Date of Report2018-12-28
Date of Event2016-07-26
Date Facility Aware2016-07-27
Report Date2016-08-05
Date Reported to FDA2016-08-05
Date Mfgr Received2016-07-27
Device Manufacturer Date2013-09-11
Date Added to Maude2018-12-31
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR. RANDAL LANDRY
Manufacturer Street5516 S.W. 1ST LANE
Manufacturer CityOCALA FL 34474
Manufacturer CountryUS
Manufacturer Postal34474
Manufacturer Phone3528542929
Manufacturer G1WINCO MFG., LLC
Manufacturer Street5516 S.W. 1ST LANE
Manufacturer CityOCALA FL 34474
Manufacturer CountryUS
Manufacturer Postal Code34474
Single Use3
Remedial ActionIN
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameWINCO
Generic NameDESIGNER CARE CLINER
Product CodeFRJ
Date Received2018-12-31
Returned To Mfg2016-09-29
Model Number6740
Catalog Number6740-28-00-HM
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Age5 YR
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerWINCO MFG., LLC
Manufacturer Address5516 S.W. 1ST LANE OCALA FL 34474 US 34474


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization 2018-12-31

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