inforMED
MalfunctionILE

COMFORT RECLINE SPACER

Received Jan 11, 2018 · Event occurred Dec 8, 2017

Report 3007802293-2018-00003 · MDR key 7184432

Device

Generic name

Comfort Recline Spacer

Manufacturer

Handicare Usa

Model number

8E4230

Product problems

  • Break
  • Torn Material
  • Break
  • Torn Material

Patient

84 YR

  • No Known Impact Or Consequence To Patient
  • No Known Impact Or Consequence To Patient

Narrative

Additional Manufacturer Narrative

(B)(4). INITIAL/FINAL REPORT WAS SENT ON DEC. 12, 2016 TO HEALTH (B)(4) FOR A COMFORT RECLINE SPACER H/S- XL SLING INVESTIGATED IN (B)(4) ON 10/31/16 VIA RGA (B)(4) . (B)(4) EVALUATED THE SLING. THE POMMEL STRAP WAS NOT ATTACHED AND WAS NOT INCLUDED WITH THE SLING. THE SLING HAS BROKEN THREADS WHERE THE POMMEL POUCH CONNECTS TO THE MAIN BODY OF THE SLING. THE POMMEL STRAP HAD BEEN PREVIOUSLY SEWN ON. THE POMMEL STRAP IS AN OPTIONAL FEATURE ADDED TO THE SLING TO KEEP THE LEGS SEPARATED. DETACHMENT DOES NO PRESENT RISK IN USE. THE POMMEL POUCH COULD BECOME DETACHED IF: GIRTH OF LEG IS TOO LARGE. THE INDIVIDUAL IS NOT CENTERED OR THE WEIGHT SHIFTS DURING LIFTING. THE INDIVIDUAL IS TOO HEAVY. THE POMMEL STRAP HAS BEEN ATTACHED TO A HOOK ON THE CARRY BAR, RATHER THAN BEING LOOPED OVER THE HIP STRAPS AS SHOWN ABOVE. ROOT CAUSE: UNABLE TO ESTABLISH DEFINITIVE ROOT CAUSE OF DETACHMENT. CORRECTIVE ACTION: CUSTOMER SERVICE CONTACTED THE CUSTOMER TO SEE IF THERE WERE QUESTIONS ON THE CORRECT METHOD OF USE FOR THE COMFORT RECLINE SPACER SLING AND HOW TO PROPERLY ATTACH THE POMMEL STRAPS AND POUCH. THEY ALSO REMINDED THE CUSTOMER THERE IS AN INSTRUCTIONAL VIDEO ON THE WEBSITE THAT CAN BE VIEWED. THE COMFORT RECLINE SLING IS SOLD WITH THE POMMEL POUCH ADDED AS AN OPTIONAL FEATURE. HANDICARE US HAS IMPLEMENTED ECR 1219 TO ADD SLIDERS TO THE POMMEL SO IT CAN BE ADJUSTED FOR LEG GIRTH AND SHIFTING OF WEIGHT.

Description of Event or Problem

DURING A LIFT, USING A COMFORT RECLINE SPACER SLING, THE POMMEL STRAP ON USED TO KEEP THE LEGS SEPARATED, DETACHED FROM THE SLING. THE SHOULDER AND LEG STAPS REMAINED ATTACHED TO THE LIFT. THE PATIENT WAS LOWERED TO THE BED AND WAS UNINJURED.