MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2019-03-28 for EEG-1200A manufactured by Nihon Kohden Corporation.
[140175572]
The customer called in because the rn pulled the plug on the equipment, causing the study autocopy to fail. They were requesting assistance copying the studies to the share folder. There is no evidence that the death event is related to the nihon kohden equipment. 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
[140175573]
The customer reported that a patient expired during an eeg study.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8030229-2019-00077 |
| MDR Report Key | 8460248 |
| Report Source | USER FACILITY |
| Date Received | 2019-03-28 |
| Date of Report | 2019-07-12 |
| Date of Event | 2019-02-28 |
| Date Facility Aware | 2019-07-12 |
| Report Date | 2019-07-12 |
| Date Reported to FDA | 2019-07-12 |
| Date Reported to Mfgr | 2019-07-12 |
| Date Mfgr Received | 2019-07-12 |
| Device Manufacturer Date | 2018-02-26 |
| Date Added to Maude | 2019-03-28 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | 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, 370-2314 |
| Manufacturer Country | JA |
| Manufacturer Postal Code | 370-2314 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NOT APPLICABLE |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EEG-1200A |
| Generic Name | NEUROFAX ELECTROENCEPHALOGRAPH |
| Product Code | OLT |
| Date Received | 2019-03-28 |
| Model Number | EEG-1200A |
| Catalog Number | EEG-1200A |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | 0 MO |
| Device Eval'ed by Mfgr | R |
| 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 | 1. Death | 2019-03-28 |