BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MAGIC MOBILITY

    MDR report key: 7479620 · Received May 2, 2018

    Report

    Report Number
    3002905561-2018-00001
    Event Type
    Malfunction
    Date Received
    May 2, 2018
    Date of Event
    January 3, 2018
    Report Date
    May 2, 2018
    Manufacturer
    MAGIC MOBILITY
    Product Code
    ITI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    THE FRONTIER WAS PURCHASED BY THE DALLAS VA. AT THE VA'S DISCRETION, THE SAID PRODUCT WAS SENT TO AMY SYSTEMS AND AN AFTER-MARKET SEATING SYSTEM WAS INSTALLED. THE WHEELCHAIR IS OLDER THAN THE STANDARD REPLACEMENT RANGE OF THE VA. THEY WILL PURCHASE THE CUSTOMER A NEW UNIT. THE VA IS ALSO TO CONSULT WITH THE CUSTOMER REGARDING THE PROPER CARE OF THE POWER WHEELCHAIR.

    Description of Event or Problem · 0

    THE CUSTOMER REPORTED TO THE VA (PER (B)(6) THAT THE CHAIR DROVE ON ITS OWN AND HIT THE BED AND WALL. AT THIS TIME IT WAS DETERMINED THE CHAIR SUSTAINED DAMAGED WIRING AND STARTED TO SPARK. THE TECHNICIAN AT THE VA STATED THAT THEY THOUGHT ONE OF THE OWNER'S CATS JUMPED ON THE JOYSTICK OF THE CHAIR. A FIRE EXTINGUISHER WAS USED ON THE CHAIR AS IT CONTINUED TO ARC. DUE TO THE SPARKS, THE CHAIR WAS PUSHED OUTSIDE. THE FIRE DEPARTMENT WAS CALLED AND THEY CUT THE WIRING.

    Additional Manufacturer Narrative · 1

    THE FRONTIER WAS PURCHASED BY THE (B)(6) VA. AT THE VA'S DISCRETION, THE SAID PRODUCT WAS SENT TO AMY SYSTEMS AND AN AFTER-MARKET SEATING SYSTEM WAS INSTALLED. THE WHEELCHAIR IS OLDER THAN THE STANDARD REPLACEMENT RANGE OF THE VA. THEY WILL PURCHASE THE CUSTOMER A NEW UNIT. THE VA IS ALSO TO CONSULT WITH THE CUSTOMER REGARDING THE PROPER CARE OF THE POWER WHEELCHAIR.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED TO THE VA (PER (B)(6)) THAT THE CHAIR DROVE ON ITS OWN AND HIT THE BED AND WALL. AT THIS TIME IT WAS DETERMINED THE CHAIR SUSTAINED DAMAGED WIRING AND STARTED TO SPARK. THE TECHNICIAN AT THE VA STATED THAT THEY THOUGHT ONE OF THE OWNER'S CATS JUMPED ON THE JOYSTICK OF THE CHAIR. A FIRE EXTINGUISHER WAS USED ON THE CHAIR AS IT CONTINUED TO ARC. DUE TO THE SPARKS, THE CHAIR WAS PUSHED OUTSIDE. THE FIRE DEPARTMENT WAS CALLED AND THEY CUT THE WIRING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    323047 MAGIC MOBILITY FRONTIER ITI MAGIC MOBILITY FRONTIER

    Patients

    Seq Age Sex Outcome Treatment
    1 Other