inforMED
MalfunctionFLE

ATLAS

Received Mar 6, 2026 · Event occurred Nov 3, 2025

Report 3005899764-2026-00019 · MDR key 24530934

Device

Generic name

Transfer Carriage

Model number

AX0650230830000013

Catalog number

AX0650230830000013

Product problems

  • Use of Device Problem

Patient

NA · Unknown

  • Pain

Narrative

Description of Event or Problem

THE USER FACILITY REPORTED THAT AN INSTRUMENT RACK UNLOADED AT AN ANGLE ON THE CART OF THEIR ATLAS TRANSFER CARRIAGE. THE EMPLOYEE ATTEMPTED TO MANUALLY LIFT THE RACK AND SUBSEQUENTLY PINCHED THEIR FINGER BETWEEN THE RACK AND CARRIAGE. MEDICAL TREATMENT WAS SOUGHT AND ADMINISTERED.

Additional Manufacturer Narrative

A STERIS SERVICE TECHNICIAN ARRIVED ONSITE FOLLOWING THE REPORTED EVENT TO INSPECT THE UNIT AND TESTED THE OPERATION AND FUNCTION OF THE UNIT. THE TECHNICIAN FOUND NO ISSUES WITH THE UNIT AND WAS UNABLE TO DUPLICATE THE REPORTED EVENT. THE UNIT WAS CONFIRMED TO BE OPERATING PROPERLY AND RETURNED TO SERVICE. THE ATLAS TRANSFER CARRIAGE OPERATOR MANUAL STATES, "RAILS ON TRANSFER CART MUST BE LEVELED FRONT TO REAR, AND ALIGNED VERTICALLY AND HORIZONTALLY WITH TRACKS INSIDE STERILIZER. FAILURE TO ADJUST TRANSFER CART RAILS AS PRESENTED IN THIS MANUAL MAY RESULT IN INJURY TO PERSONNEL OR DAMAGE TO PRODUCT AND EQUIPMENT." THE OPERATOR MANUAL ALSO STATES, "WARNING - PREVENT PHSYICAL INJURY: GET HELP IF LOADING CAR BECOMES STUCK OR DIFFICULT TO MOVE. DO NOT ATTEMPT TO LIFT A LOADING CAR WITHOUT ASSISTANCE." THE TECHNICIAN COUNSELED USER FACILITY PERSONNEL ON THE PROPER USE AND OPERATION OF THE ATLAS TRANSFER CARRIAGE, SPECIFICALLY ON NOT MANUALLY LIFTING THE LOADING CAR WITHOUT ASSISTANCE. NO ADDITIONAL ISSUES HAVE BEEN REPORTED.