COMPAX 40E
Received Feb 26, 2009 · Event occurred Feb 1, 2009
Report 2126677-2009-00011 · MDR key 1334720
Device
Product problems
- Device Slipped
- Unintended Movement
Patient
NA
- No Known Impact Or Consequence To Patient
Narrative
Description of Event or Problem
IT WAS REPORTED THE TABLE LOCKS DID NOT ACTUATE, CAUSING THE TABLETOP TO UNEXPECTEDLY MOVE IN BOTH LONGITUDINAL AND LATERAL DIRECTIONS WITHOUT RESISTANCE (FREE FLOAT). THERE WAS NO INJURY REPORTED. THIS SITUATION COULD CONTRIBUTE TO AN INJURY IF A PATIENT OR OPERATOR WERE UNAWARE OF THIS CONDITION WHILE LOADING OR UNLOADING A PATIENT. THE ENSUING INSTABILITY COULD LEAD TO A FALL.
Additional Manufacturer Narrative
PRELIMINARY INSPECTION PERFORMED BY THE GE FIELD ENGINEER (FE) REVEALED THAT THE ALLEGED FLOAT WAS CAUSED BY POWER LOSS TO THE TABLE LOCKS DUE TO A BLOWN FUSE. THE FE REPLACED THE FUSE, BUT IT WAS REPORTED THAT THE POWER LOSS REOCCURRED THE NEXT DAY. FURTHER INVESTIGATION SHOWED THAT THE LEFT TABLE HORIZONTAL LOCK WAS LOOSE. HARDWARE HAD FALLEN OUT AND THE LOCK WAS MOVING AROUND AND WAS INTERMITTENTLY SHORTING OUT AGAINST TERMINAL STRIP, HENCE BLOWING THE FUSE. THE FE FASTENED THE LOCK BACK INTO PLACE AND VERIFIED THAT THE REPORTED ISSUE DID NOT RECUR.