MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2019-01-04 for EEG-1200A manufactured by Nihon Kohden Corporation.
[132513778]
The eeg tech reported that the caster on cart for the eeg system came off. They stated that the bolt that held the caster in place sheered and caused it to fall off. No patient harm or injury reported. Nihon kohden continues to investigate the reported event. Nihon kohden will submit a supplemental report in accordance with 21 cfr section 803. 56 if additional information becomes available.
Patient Sequence No: 1, Text Type: N, H10
[132513779]
The eeg tech reported that the caster on cart for the eeg system came off. They stated that the bolt that held the caster in place sheered and caused it to fall off. No patient harm or injury reported.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8030229-2019-00002 |
| MDR Report Key | 8220331 |
| Report Source | USER FACILITY |
| Date Received | 2019-01-04 |
| Date of Report | 2019-01-03 |
| Date of Event | 2018-12-11 |
| Date Facility Aware | 2018-12-11 |
| Report Date | 2019-01-03 |
| Date Reported to FDA | 2019-01-03 |
| Date Reported to Mfgr | 2019-01-03 |
| Date Mfgr Received | 2019-01-03 |
| Date Added to Maude | 2019-01-04 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. SHAMA MOOMAN |
| Manufacturer Street | SAFETY MGMT DEPT, QUALITY MGMT SEIBU BLDG 2, 4TH FLOOR 1-11-2 |
| Manufacturer City | KUSUNOKIDAI TOKOROZAWA, SAITAMA 359-8580 |
| Manufacturer Country | JA |
| Manufacturer Postal | 359-8580 |
| Manufacturer G1 | NIHON KOHDEN TOMIOKA CORPORATION |
| Manufacturer Street | 1-1 TAJINO ATTN: SHAMA MOOMAN |
| Manufacturer City | TOMIOKA CITY, GUNMA 370-2314 |
| Manufacturer Country | JA |
| Manufacturer Postal Code | 370-2314 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EEG-1200A |
| Generic Name | NEUROFAX ELECTROENCEPHALOGRAPH |
| Product Code | OLT |
| Date Received | 2019-01-04 |
| Model Number | EEG-1200A |
| Catalog Number | EEG-1200A |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | NIHON KOHDEN CORPORATION |
| Manufacturer Address | 1-31-4 NISHIOCHIA, SHINJUKU-KU ATTN: SHAMA MOOMAN TOKYO, 161-8560 JA 161-8560 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-01-04 |