MAUDE MDR 4404544

MDR report key
4404544
Report number
3008869754-2015-00001
Event key
0
Event type
3
Date of event
2013-10-01
Date received
2015-01-06
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
RICHARD SMITH
Address
4 CROSBY DR BEDFORD MA 01730 US
Phone
781-781-7817
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1BIOM T2ASSEMBLY, KNEE/SHANK/ANKLE/FOOT, EXITIWALK INC.ISWBIOM T211-00ANAR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-01-0601. R

Event Narratives#

D

Patient 1

USER OF THE PROSTHESIS (ANKLE/FOOT) REPORTED THAT OVER A YEAR EARLIER, HE HAD FALLEN AND BROKEN THE PATELLA IN HIS SOUND LEG (THE LEG WITHOUT THE PROSTHESIS). HE REPORTED THAT WHILE PUSHING A HEAVY TRASH CAN, HE STUBBED THE TOE OF THE BIOM DEVICE WHICH PROMPTED IT TO PROVIDE POWER AS IT IS DESIGNED TO DO ON TOE OFF, AND THAT THE POWERED PUSH OFF PUT HIM OFF BALANCE, RESULTING IN A FALL WHICH DROVE HIS GOOD KNEE INTO THE GROUND, BREAKING THE PATELLA. USER REPORTED THAT THE BIOM WAS NOT THE CAUSE OF THE FALL LEADING TO HIM BREAKING HIS PATELLA PER SE, BUT THAT THE POWER PROVIDED ON THE TOE OFF CONTRIBUTED TO HIM LOSING HIS BALANCE AND FALLING. NO MALFUNCTION OF THE DEVICE WAS REPORTED AND THE DEVICE HAS CONTINUED TO FUNCTION NORMALLY SINCE THE EVENT.

N

Patient 1

THE USER FIRST INFORMED AN IWALK REP OF THE FALL ON (B)(6) 2013, BUT MADE NO INDICATION THAT TREATMENT WAS REQUIRED FOR THE INQUIRY OR THAT HE FELT THE BIOM WAS AT FAULT AT THAT TIME, AND REFERENCED THE FALL ONLY TO EXPLAIN WHY HE HAD NOT CORRESPONDED IN SOME TIME. A YEAR LATER, ON (B)(6) 2014, DURING ANOTHER CHECK-IN WITH THE USER, HE THEN INDICATED THAT HE FELT BIOM DEVICE WAS A CONTRIBUTING FACTOR IN THE FALL AND RESULTING INJURY TO HIS PATELLA THE PREVIOUS YEAR. THERE IS NO INDICATION OF A MALFUNCTION, AND THE USER HAS CONTINUED TO USE THE DEVICE SINCE THE INCIDENT. SINCE THE USER INDICATED THAT THE DEVICE MAY HAVE CONTRIBUTED TO A FALL LEADING TO SURGICAL INTERVENTION, THIS INCIDENT IS CONSIDERED A REPORTABLE EVENT.