MAUDE MDR 1553732

MDR report key
1553732
Report number
3003508375-2009-00010
Event key
0
Event type
3
Date of event
2009-11-20
Date received
2009-11-25
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MICHAEL O'MEARA, DIRECTOR
Address
ROUTE 22 W SOMERVILLE NJ 08876 US
Phone
908-908-9087
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1INDEPENDENCE IBOT 4000 MOBILITY SYSTEMSTAIR CLIMBING WHEELCHAIRINDEPENDENCE TECHNOLOGY, L.L.C.IMKNAIT004708NAR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12009-11-2501. O

Event Narratives#

D

Patient 1

USER REPORTED THAT HE SUSTAINED A CONTUSION TO HIS LEFT SHOULDER WHEN HE FELL FORWARD APPROX. 16 STEPS WITH THE DEVICE WHILE DESCENDING STADIUM STYLE STAIRS IN SOLO STAIR FUNCTION. USER REPORTED THAT THE DEVICE STARTED TO FALL FORWARD, THEN TURNED TO THE SIDE, ENDING UP ON ITS LEFT SIDE, WHICH IS THE SAME SIDE AS THE REPORTED SHOULDER CONTUSION. USER WENT TO THE ER TO BE EVALUATED. OUTCOME OF X-RAY WAS NEGATIVE FOR FRACTURE / OTHER INJURY, EXCEPT FOR REPORTED CONTUSION, FOR WHICH ORDERS WERE GIVEN TO ICE SHOULDER FOR 24 HOURS AND WARM MASSAGES THEREAFTER. (B)(4).

N

Patient 1

PER NORMAL PROCEDURE, THE CUSTOMER SUPPORT CENTER (CSC) RETRIEVED THE REMOTE SERVICE CODE FROM THE DEVICE WITH THE ASSISTANCE OF THE USER, TO TROUBLESHOOT THE REPORTED EVENT AND HELP DETERMINE IF A MALFUNCTION MAY HAVE OCCURRED. THE RETRIEVED CODE INDICATED THAT THE PITCH LIMIT OF THE DEVICE HAD BEEN EXCEEDED WHILE IN STAIR FUNCTION. THIS IS CONSISTENT WITH THE REPORTED EVENT. NO OTHER INDICATIONS OF A FAULT OR DEVICE MALFUNCTION WERE DETECTED. THE REPORTED EVENT IS CONSISTENT WITH IMPROPER OR INCORRECT TECHNIQUE WHILE STAIR CLIMBING. IN STAIR FUNCTION, THE USER IS AN INTEGRAL COMPONENT OF THE FUNCTION AND MUST MAINTAIN CONTROL OF THE DEVICE IN ORDER TO NEGOTIATE STAIRS. THE CSC ALSO REMINDED THE USER TO BE AWARE OF STEP HEIGHT AND DEPTH WHEN STAIR CLIMBING.