inforMED
MalfunctionFLE

ATLAS TRANSFER CARRIAGE

Received Jun 5, 2024 · Event occurred May 9, 2024

Report 3005899764-2024-00025 · MDR key 19472905

Device

Generic name

Transfer Carriage

Product problems

  • Device Dislodged or Dislocated
  • Device Dislodged or Dislocated

Patient

NA · Unknown

  • Laceration(s)
  • Laceration(s)

Narrative

Additional Manufacturer Narrative

A STERIS SERVICE TECHNICIAN ARRIVED ON SITE AND FOUND THAT THE ATLAS TRANSFER CARRIAGE'S CART TRACK WAS NOT ADJUSTED TO THE PROPER STERILIZER HEIGHT. AS THE CART TRACK WAS OUT OF ALIGNMENT, THE USER WAS UNABLE TO PROPERLY INSERT THE CART INTO THE STERILIZER. AS THE USER WAS LIFTING THE CART INTO THE STERILIZER, THE CART SLIPPED AND INJURED THEIR INDEX FINGER. THE SUBCONTRACTOR RESPONSIBLE FOR INSTALLATION WAS RETRAINED ON THE PROPER INSTALLATION PROCEDURE. THE TECHNICIAN ADJUSTED THE HEIGHT OF THE ATLAS TRANSFER CARRIAGE, TESTED THE UNIT AND CONFIRMED IT TO BE OPERATING ACCORDING TO SPECIFICATION. NO ADDITIONAL ISSUES HAVE BEEN REPORTED.

Description of Event or Problem

THE USER FACILITY REPORTED THAT AN EMPLOYEE OBTAINED AN INJURY TO THEIR HAND (LACERATION) WHILE OPERATING THEIR ATLAS TRANSFER CARRIAGE. MEDICAL TREATMENT WAS SOUGHT AND ADMINISTERED (SKIN ADHESIVE).