# NTSB ERA21FA135: Vans RV7, N383DB, Mayfield, KY, February 22, 2021

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Class 3 · Field · Final report
- Date: February 22, 2021, 17:56 local (23:56 UTC)
- Place: Mayfield, KY
- Coordinates: 36.779157, -88.584105 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=36.7792&lon=-88.5841&mi=10
- Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping)
- Defining event: [Initial climb: Loss of control in flight](https://openairdocs.org/ntsb-events/240)
- Highest injury: Fatal
- Injuries: 1 fatal
- Status: Completed
- Report: Approved by Office Director
- Investigation class: Class 3
- NTSB office: Eastern Region Aviation
- Parties: FAA FSDO, Lycoming Engines
- NTSB case key (mKey): 102659
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA21FA135
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/102659/pdf
- NTSB docket: https://data.ntsb.gov/Docket?ProjectID=102659
- Page: https://openairdocs.org/ntsb/ERA21FA135

## Probable cause

The pilot's exceedance of the airplane’s critical angle of attack, which resulted in an aerodynamic stall, loss of airplane control, and subsequent impact with terrain.

## Findings

NTSB's coded findings; those marked are part of the probable cause.

- [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Babenco Henry D VANS RV-7A, 1 case](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=056208U), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md)
- [Performance/control parameters: angle of attack](https://openairdocs.org/ntsb-findings/01062042): Aircraft › Aircraft oper/perf/capability · Capability exceeded (probable cause); cases with it: [Babenco Henry D VANS RV-7A, 1 case](https://openairdocs.org/ntsb-findings/01062042/cases.md?model=056208U), [All aircraft, 990 cases](https://openairdocs.org/ntsb-findings/01062042/cases.md)
- [Performance/control parameters: airspeed](https://openairdocs.org/ntsb-findings/01062010): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Babenco Henry D VANS RV-7A, 1 case](https://openairdocs.org/ntsb-findings/01062010/cases.md?model=056208U), [All aircraft, 1,681 cases](https://openairdocs.org/ntsb-findings/01062010/cases.md)

## Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event best describes what happened.

- [Initial climb: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [Babenco Henry D VANS RV-7A, 1 case](https://openairdocs.org/ntsb-events/240/sequence.md?model=056208U), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md)
- [Uncontrolled descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Babenco Henry D VANS RV-7A, 1 case](https://openairdocs.org/ntsb-events/470/sequence.md?model=056208U), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md)

## Analysis

The private pilot was conducting touch-and-go landings in the experimental, amateur-built airplane. A witness stated that, during the departure climb, “as the airplane went higher…the tail dropped, and the plane went into a back flip.” The witness then observed the airplane come out of the “flip” and descend “nose first” toward the ground. The airplane subsequently impacted terrain north of the departure airport. Another witness reported that he observed the airplane climbing at a high angle of attack during the takeoff. Postaccident examination of the accident site revealed that the wreckage was confined to a small area, which was consistent with a near-vertical impact. The wings showed symmetrical accordion-like crushing damage. Examination of the airframe and engine revealed no evidence of preimpact mechanical malfunctions or anomalies. According to the available evidence for this accident, the pilot likely exceeded the airplane’s critical angle of attack and entered an aerodynamic stall, resulting in the pilot’s loss of airplane control and the airplane’s subsequent impact with terrain.

## Factual narrative

On February 22, 2021, about 1756 central standard time, an experimental, amateur-built Vans RV-7A airplane, N383DB, was substantially damaged when it was involved in an accident near Mayfield Graves County Airport (M25), Mayfield, Kentucky. The private pilot was fatally injured. The airplane was operated under the provisions of Title 14 Code of Federal Regulations Part 91 as a personal flight. A witness at M25 stated the airplane was conducting touch-and-go landings on runway 1. Another witness traveling eastbound on a nearby interstate saw the airplane climbing and reported that, “as the airplane went higher…the tail dropped, and the plane went into a back flip. This witness then observed the airplane come out of the “flip” and descend “nose first” toward the ground. The airplane subsequently impacted an open field located about 1,011 ft north of the airport. Another witness reported that he observed the airplane takeoff and noted that it was climbing at a high angle of attack. The wreckage was confined to a small area. All airplane components were accounted for at the accident site, and flight control continuity was confirmed for all control surfaces. The wings exhibited symmetrical accordion-type crushing damage and remained attached to the fuselage. Both wing fuel tanks were breached, and both fuel main caps were found in place. The empennage, main landing gear, and all control surfaces also remained attached to the fuselage. The engine and nose landing gear separated from the forward fuselage. The engine was rotated by hand at the accessory gear section, and crankshaft continuity was confirmed. Thumb compression was attained on all cylinders. The engine-driven fuel pump contained 100 low-lead aviation fuel and produced suction and pressure when activated by hand. The left magneto was impact damaged and was not able to be rotated. The right magneto produced spark on all towers. The two-bladed propeller was found fractured from the engine due to impact forces. One blade exhibited rearward bending and leading-edge gouges, and the other blade exhibited S bending. Examination of the airframe and engine revealed no preimpact mechanical malfunctions or anomalies that would have precluded normal operation.

## Aircraft

- Registration: [N383DB](https://openairdocs.org/deregistered/N383DB-2022-09-03), registration cancelled 2022-09-03, S/N 72319, built 2011 (OpenAirDocs)
- Reported make and model: VANS RV7 (A)
- Registry model: [Babenco Henry D VANS RV-7A](https://openairdocs.org/model/babenco-henry-d-vans-rv-7a) (registry code 056208U) (OpenAirDocs)
- Registry engine: [Lycoming IO-360-M1B](https://openairdocs.org/engine/lycoming-io-360-m1b) (registry code 41871, reciprocating) (OpenAirDocs)
- Category: Airplane, amateur-built
- Serial number: 72319
- Year built: 2011
- Engines: LYCOMING IO-360-M1B 180 horsepower reciprocating
- Damage: Substantial damage
- Flight: Personal, Part 91
- Registered owner: Babenco Henry D
- Airworthiness certificate: Special, Experimental (Special)
- Last inspection: Condition, January 17, 2011
- Departed: M25, Mayfield, KY
- Airport: M25, Mayfield Graves County, runway 01/19, 5,002 × 100 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 60; injuries: fatal; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, without waivers/limitations; seat: left; toxicology performed; flight hours: 1,490 total

## Weather

- Conditions: Visual (VMC), Day
- Wind: 200° at 7 knots
- Visibility: 10 statute miles
- Temperature: 45 °F, dew point 30 °F
- Altimeter: 30.05 inHg
- Observed at: CEY, 12 nm away
- METAR: KCEY 222355Z AUTO 20007KT 10SM CLR 07/M01 A3005 RMK AO1

## FAA reports on this event (1)

The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs).

- [Accident 20210222000259A](https://openairdocs.org/incident/20210222000259A), Feb 22, 2021: Babenco Henry D VANS RV-7A, Mayfield, KY, Substantial damage, 1 fatal. The aircraft was found in a field approximately one quarter of a mile north of the Mayfield, KY airport (M25) and directly inline with the runway centerline.…

## Docket (10 files)

The files NTSB released with the investigation on June 22, 2023, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=102659. 16.1 MB in all.

- Memorandum for record a�� witness statements (item 1, PDF, 4 pages, 116 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15622875&FileExtension=pdf&FileName=MOR%20template-4pak_Redacted-Rel.pdf
- Maintenance record excerpts (item 2, PDF, 10 pages, 6.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15591609&FileExtension=pdf&FileName=MxLog-Array_Redacted-Rel.pdf
- Investigative photographs (item 3, PDF, 3 pages, 2.0 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15621779&FileExtension=pdf&FileName=ERA21FA135%20Investigative%20Photographs-Red-Rel.pdf
- Wreckage examination report (item 4, PDF, 28 pages, 6.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15622211&FileExtension=pdf&FileName=FINAL-Examination%20final-Rel.pdf
- Toxicological report (item 5, PDF, 1 page, 128 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15302831&FileExtension=pdf&FileName=Toxicology%20Report_Redacted-Rel.pdf
- Memorandum for record-medical and pathological information (item 6, PDF, 1 page, 174 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=12116756&FileExtension=pdf&FileName=Memorandum%20for%20Record-Medical%20and%20Pathological%20Information%20ERA21FA135-Rel.pdf
- Memorandum for record a�� edm data (item 7, PDF, 1 page, 65 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15624349&FileExtension=pdf&FileName=MOR%20-%20EDM_Redacted-Rel.pdf
- Evidence control form (item 8, PDF, 1 page, 664 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15083261&FileExtension=pdf&FileName=N383DB%20Evidence%20Control%20Form_Redacted-Rel.pdf
- Certification of party representative - Lycoming (item 9, PDF, 14 pages, 137 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15590861&FileExtension=pdf&FileName=N383DB%20Lyc%20Party%20Form_Redacted-Rel.pdf
- Wreckage release (item 10, PDF, 1 page, 93 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=15084612&FileExtension=pdf&FileName=Wreckage%20Release_N383DB_Redacted-Rel.pdf

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

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