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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: PERMOBIL INC. PERMOBIL F5 CORPUS VS; POWERED WHEELCHAIR

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PERMOBIL INC. PERMOBIL F5 CORPUS VS; POWERED WHEELCHAIR Back to Search Results
Model Number F5 CORPUS VS
Device Problems Mechanical Problem (1384); Unintended System Motion (1430); Unintended Movement (3026)
Patient Problems Abrasion (1689); Fall (1848)
Event Date 01/27/2021
Event Type  malfunction  
Manufacturer Narrative
The end-user claimed while attempting to reposition the seating via the switchbox, when initiating a tilt function, the seating was alleged as having started a stand function.End-user alleged when releasing the button on the switchbox, the seating continued to operate without control into a standing positioning.End-user claimed having attempted to hit every button to stop, but the seating continued to stand until the end-user reported losing positioning and fell forward out of the seating into some nearby bushes.Reports indicate the end-user sustained minor scratches and abrasions that did not require medical intervention.Review of device history indicated previous reports of operational anomalies that were determined to have been caused by the device electronics having been exposed to water.Replacement components were ordered and installed approximately 1.5 months prior to this reported event.After report of this event, the device has been removed from service and end-user provided with a new power wheelchair.An inspection and evaluation of the device was performed by permobil representatives who found the device to be fully operational with no indications or evidence of a failure or deviation in functionality having occurred.At this time, permobil was unable to duplicate any unintentional operation as alleged nor find any evidence to substantiate a failure has occurred.Permobil has requested the device be returned to the manufacturing site for further evaluation in effort to determine a potential root cause.If/when upon completion of evaluation, any new information or findings are discovered, a follow-up report will be submitted.The dhr was reviewed and the device was found to have met specification prior to distribution.
 
Event Description
Received report where end-user alleged the seat functions moved on their own which caused the seating to go into a stand.This action reportedly caused the end-user to lose positioning and fall out of the seating.No serious injuries occurred as a result.
 
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Brand Name
PERMOBIL F5 CORPUS VS
Type of Device
POWERED WHEELCHAIR
Manufacturer (Section D)
PERMOBIL INC.
300 duke drive
lebanon TN 37090
Manufacturer (Section G)
PERMOBIL INC.
300 duke drive
lebanon TN 37090
Manufacturer Contact
kevin bullock
300 duke drive
lebanon, TN 37090
8007360925
MDR Report Key11347666
MDR Text Key232555101
Report Number1221084-2021-00005
Device Sequence Number1
Product Code ITI
UDI-Device Identifier17330818001006
UDI-Public17330818001006
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K191874
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative
Reporter Occupation Non-Healthcare Professional
Type of Report Initial
Report Date 02/19/2021
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Lay User/Patient
Device Model NumberF5 CORPUS VS
Device Catalogue NumberN/A
Device Lot NumberN/A
Was Device Available for Evaluation? Yes
Initial Date Manufacturer Received 01/29/2021
Initial Date FDA Received02/19/2021
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured10/25/2019
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Weight116
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