MAUDE MDR 5095286

MDR report key
5095286
Report number
1060680-2015-00041
Event key
0
Event type
3
Date of event
2015-08-28
Date received
2015-09-22
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
DR. MARIAN VARGAS
Address
200 DEBUSK LANE POWELL TN 37849 US
Phone
865-865-8653
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1DEROYALFULL SHELL WALKER 2, LARGEDEROYAL INDUSTRIES, INC.KNP1-524A-04-CFSM86275Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-09-2201. O

Event Narratives#

N

Patient 1

INVESTIGATION FINDINGS: THE RETURNED PRODUCT IS VERY WELL WORN. THE LINER DEVELOPED SEVERAL HOLES DURING WEAR AND USE. THERE WERE TWO HOLES AT THE TOP OF THE BOOT AND ONE AT THE HEEL (SEE ATTACHED FILES (B)(4)). THESE HOLES GO ALL THE WAY THROUGH THE FOAM LINER, ALLOWING THE LEG TO BE EXPOSED TO THE HOOK TABS THAT ARE PLACED INSIDE THE FRAME TO SECURE THE LINER TO THE SHELL. THESE HOLES FORM DURING WEAR/USE WHEN THE STRAPS ARE NOT PROPERLY TIGHTENED. LOOSE STRAPS ALLOW THE LINER/LEG TO MOVE/RUB AGAINST THE HOOK TABS INSIDE THE SHELL, CAUSING THE FOAM MATERIAL TO BREAK DOWN. THERE WAS NO VENDOR DEFECT WAS FOUND. CORRECTION: CREDIT WAS REQUESTED/ISSUED. ROOT CAUSE ANALYSIS: THE COMPLAINT INVESTIGATOR FOUND NO VENDOR OR MANUFACTURING DEFECT. IT APPEARS THAT THE STRAPS MAY NOT HAVE BEEN TIGHTENED ENOUGH TO ELIMINATE LEG/LINER MOVEMENT WITHIN THE SHELL. CORRECTIVE ACTION AND/OR SYSTEMIC CORRECTION ACTION TAKEN: THERE IS NO ACTION REQUIRED AT THIS TIME, NO VENDOR/MANUFACTURING DEFECT WAS FOUND. PREVENTIVE ACTION: THERE IS NO ACTION REQUIRED AT THIS TIME, SINCE NO VENDOR OR MANUFACTURING DEFECT WAS FOUND.

D

Patient 1

BELOW IS A COPY OF THE COMPLAINT CALL QUESTIONS ASKED BY DEROYAL ABOUT THE EVENT AND THE CORRESPONDING RESPONSES MADE BY THE INITIAL REPORTER. WHEN DID QUALITY ISSUE OCCUR? DURING USE. WHO WAS USING OR OPERATING THE PRODUCT WHEN THE QUALITY ISSUE OCCURRED? PATIENT WAS A MEDICAL PROCEDURE INVOLVED? NO. DID THE QUALITY ISSUE CAUSE A DELAY IN THE MEDICAL PROCEDURE? NOT APPLICABLE. DETAILED DESCRIPTION OF QUALITY ISSUE: I REPLACED THIS PATIENT'S LARGE, TALL PNEUMATIC WALKING BOOT BECAUSE THE MATERIAL WAS COMING APART AT THE HEEL AND CAUSING PAIN. THE PAIN WAS ON THE HEEL. THERE WAS NO INJURY OR BLISTER REPORTED. HOW WAS THE QUALITY ISSUE WAS IDENTIFIED? BY ACTUAL USE. HOW WAS THE PRODUCT BEING USED? ON THE FOOT. WAS IT THE INITIAL USE OF THE PRODUCT? YES. WAS THE PRODUCT MODIFIED FROM THE ORIGINAL CONDITION SUPPLIED BY DEROYAL? NO. WAS THE PRODUCT CONNECTED TO OR USED IN CONJUNCTION WITH OTHER DEVICES OR EQUIPMENT? NO. DETAILED DESCRIPTION OF OUTCOME(S), INCLUDING INFORMATION REGARDING INJURY OR ANY ADDITIONAL TREATMENT/INTERVENTION REQUIRED: PATIENT WAS GIVEN A NEW BRACE.