MAUDE MDR 9655874

MDR report key
9655874
Report number
1221084-2020-00002
Event key
0
Event type
3
Date of event
2020-01-06
Date received
2020-01-31
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. KEVIN BULLOCK
Address
300 DUKE DRIVE LEBANON TN 37090 US
Phone
800-800-8007
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PERMOBIL F5POWERED WHEELCHAIRPERMOBIL INC.ITIF5N/AN/AY Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-01-3101. H

Event Narratives#

N

Patient 1

THE END-USER REPORTED THEY HAD JUST COME TO THE BOTTOM OF THE RAMP THAT LEADS FROM THEIR HOME TO AN OUTDOOR SCREENED PORCH WHEN THE DEVICE REPORTEDLY CONTINUED TO DRIVE. THE END-USER CLAIMED THEY HAD REMOVED THEIR HAND FROM THE JOYSTICK, BUT THE DEVICE CONTINUED TO DRIVE UNTIL IT IMPACTED WITH THE ALUMINUM SIDING OF THE SCREENED ROOM. REPORT CLAIMED THE END-USER HAD RE-INJURED A TOE ON THEIR LEFT FOOT WHICH HAD BEEN BROKEN PREVIOUSLY FROM AN SIMILAR INCIDENT APPROXIMATELY 2 WEEKS PRIOR. THE PREVIOUS EVENT WAS NEVER REPORTED TO PERMOBIL, BUT DESCRIPTION OF THAT EVENT WAS IDENTICAL IN EVERY RESPECT IN THAT IT OCCURRED IN THE SAME LOCATION WITH THE SAME ALLEGATION OF CONTINUED DRIVE WITH COLLISION INTO SCREEN PORCH ALUMINUM STRUCTURE. SERVICE PROVIDER STATED THEY DID NOT REPORT THE ORIGINAL INCIDENT TO PERMOBIL AS THEY CONSIDERED THAT EVENT AS USE ERROR. PROVIDER REPORTS HAVING EVALUATED THE DEVICE FINDING NO ISSUES THAT WOULD INDICATE A PRODUCT MALFUNCTION HAVING OCCURRED. AFTER RECEIVING A SECOND REPORT OF FAILURE TO STOP, PERMOBIL WAS NOTIFIED. THE DEVICE WAS RE-EVALUATED AFTER THE SECOND REPORTED EVENT TO WHICH THE DEVICE WAS AGAIN FOUND TO BE FULLY OPERATIONAL WITH THE DEVICE COMING TO A FULL AND COMPLETE STOP EACH TIME THE JOYSTICK WAS RELEASED. MULTIPLE ATTEMPTS TO RECREATE THE REPORTED ANOMALY WERE CONDUCTED TO WHICH THE DEVICE OPERATED NORMALLY WITHOUT ANY DEVIATION OR HESITATION IN DRIVE CONTROLS. NO REPORTS WERE RELAYED TO THE PROVIDER OF THE DEVICE HAVING OPERATED ABNORMALLY, IN ANY OTHER SITUATION OR LOCATION, OTHER THAN THE 2 INSTANCES REPORTED HAVING OCCURRED AT THE SAME LOCATION. THE DEVICE WAS INSPECTED AND FOUND TO BE IN PROPER WORKING CONDITION WITH NO NOTABLE DEFICIENCIES. THE DHR WAS REVIEWED AND THE DEVICE MET SPECIFICATION PRIOR TO DISTRIBUTION.

D

Patient 1

RECEIVED REPORT AS END-USER WAS DRIVING DOWN A RAMP FROM A 3" RISE, THE DEVICE WAS REPORTED TO HAVE CONTINUED TO DRIVE AFTER THE END-USER HAD REMOVED THEIR HAND FROM THE JOYSTICK. REPORTS ALLEGE THE CHAIR FAILED TO STOP AND CONTINUED FORWARD CAUSING THE END-USERS FOOTPLATES TO CONTACT AN ALUMINUM WALL OF A SCREEN PORCH. REPORT INDICATED THE END-USER RE-INJURED HIS TOE FROM A PREVIOUS (NON REPORTED) INCIDENT.