MAUDE MDR 7899903

MDR report key
7899903
Report number
3032618-2018-00009
Event key
0
Event type
3
Date of event
2018-08-24
Date received
2018-09-21
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
3
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. BRIAN ENGLISH
Address
2701 W COURT ST PASCO WA 99301 US
Phone
509-509-5095
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ZRAWHEELCHAIR ANTI-TIPTISPORT, LLCIMRZRAR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-09-210

Event Narratives#

N

Patient 1

NO INJURY WAS REPORTED IN THIS EVENT. THERE IS A RISK OF SERIOUS INJURY IN THE CASE OF A FAILURE OF THE ANTI-TIPS WHILE ENGAGED. IT IS UNCLEAR WHETHER THE USER WAS RECLINED ON THE ANTI-TIPS, OR PROPELLING WITH THE ANTI-TIPS BEING USED AS WHEELS INSTEAD OF THE FRONT CASTERS, WHICH ARE NOT RECOMMENDED BY THE OWNERS MANUAL, BUT THE OWNERS MANUAL DOES RECOMMEND IN CHAPTER 1 SECTION I: -2. NEVER USE YOUR CHAIR ON A SLOPE GREATER THAN 10% -9 ALWAYS LEAN OR PRESS YOUR BODY IN THE UPHILL DIRECTION. THIS WILL HELP SHIFT YOUR WEIGHT TO COUNTERACT THE CHANGE IN THE CENTER OF BALANCE CAUSED BY THE HILL, SLOPE OR RAMP. THE OWNERS MANUAL ALSO WARNS IN CHAPTER 1 WARNINGS SECTION A -2. IF YOUR ANTI-TIPS ARE SET TOO LOW, THEY MAY "CATCH" ON OBSTACLES THAT YOU CAN EXPECT TO ENCOUNTER IN NORMAL WHEELCHAIR USE. IF THIS HAPPENS, YOU MAY TIP OVER AND FALL. -4. ALWAYS KEEP YOUR ANTI-TIPS LOCKED IN PLACE IN THE "DOWN" POSITION UNLESS: --A. YOU HAVE AN ATTENDANT (BUT YOUR ATTENDANT MUST ROTATE THE ANTI-TIPS INTO THE "DOWN" POSITION WHENEVER HE OR SHE LEAVES YOU UNATTENDED IN YOUR CHAIR, EVEN FOR A MOMENT), OR --B. YOU HAVE TO CLIMB OR DESCEND A CURB OR STEP OR OVERCOME AN OBSTACLE. EVEN IF THIS IS THE CASE, ONLY UNLOCK THE ANTI-TIPS IF YOU CAN SAFELY CLIMB OR DESCEND THE CURB OR STEP OR OVERCOME THE OBSTACLE AND MAKE SURE THE ANTI-TIPS ARE LOCKED IN THE "UP" POSITION A REVIEW OF THE DHR INDICATES THAT THE WHEELCHAIR PASSED ALL APPLICABLE QUALITY TESTS AND CONFIGURATION REQUIREMENTS, AND MET ALL SPECIFICATIONS AS ORDERED BY THE DEALER WHEN IT LEFT THE FACILITY. THE ANTI-TIP IN QUESTION WAS REQUESTED TO BE RETURNED, BUT HAS NOT YET BEEN RETURNED. WE DO NOT HAVE ANY FURTHER INFORMATION ABOUT THE EVENT, OTHER THAN THESE ALLEGATIONS AT THIS TIME. IF MORE INFORMATION IS PROVIDED THAT CHANGES THE NATURE OF THE INVESTIGATION, A FOLLOW UP MEDWATCH FORM 3500A WILL BE FILED.

D

Patient 1

CUSTOMER ALLEGES THAT THE ANTI-TIP EXTENSION ON A USER FRIENDLY ANTI-TIP BROKE DURING USE. THE END USER WAS REPORTEDLY NOT INJURED. ANTI-TIPS IN QUESTION WERE ORDERED SEPARATELY FROM THE CHAIR ON (B)(6) 2018.