MAUDE Adverse Event Report: NIHON KOHDEN CORPORATION CNS-6201A; CENTRAL MONITOR SYSTEM

Model Number CNS-6201A

Device Problems No Display/Image (1183); Power Problem (3010)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 10/17/2022

Event Type  malfunction  

Manufacturer Narrative

The customer reported that the power brick on this central nurse's station (cns) monitor does not work anymore.The customer was able to replace the power brick, but would like to replace the brick for their own replenishment.There was no patient 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 when additional information becomes available.

Event Description

The customer reported that the power brick on this central nurse's station (cns) monitor does not work anymore.There was no patient injury reported.

Manufacturer Narrative

Details of complaint: the customer reported that the power brick on this central nurse's station (cns) monitor does not work anymore.The customer was able to replace the power brick, but would like to replace the brick for their own replenishment.There was no patient injury reported.Investigation summary: based on the available information, a definitive root cause could not be identified.The following fields contain no information (ni), as attempts to obtain information were made, but not provided: a2 - a6 attempt # 1: (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.Attempt # 2: (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.Attempt # 3 (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.B6 attempt # 1: (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.Attempt # 2: (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.Attempt # 3 (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.B7 attempt # 1: (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.Attempt # 2: (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.Attempt # 3 (b)(6) 2022 emailed the customer via microsoft outlook for patient information: no reply was received.D10 attempt # 1: (b)(6) 2022 emailed the customer via microsoft outlook for device information: no reply was received.Attempt # 2: (b)(6) 2022 emailed the customer via microsoft outlook for device information: no reply was received.Attempt # 3 (b)(6) 2022 emailed the customer via microsoft outlook for device information: no reply was received.Additional information: b4 date of this report g3 date received by manufacturer g6 type of report h2 if follow up, what type? h10 additional manufacturer narrative manufacturer references # (b)(4).Follow up 001.

Event Description

The customer reported that the power brick on this central nurse's station (cns) monitor does not work anymore.There was no patient injury reported.

• Brand Name: CNS-6201A
• Type of Device: CENTRAL MONITOR SYSTEM
• Manufacturer (Section D): NIHON KOHDEN CORPORATION; attn: shama mooman; 1-31-4 nishiochia; shinjuku-ku, tokyo 161-8 560; JA 161-8560
• Manufacturer (Section G): NIHON KOHDEN TOMIOKA CORPORATION; attn: shama mooman; 1-1 tajino; tomioka city, gunma 370-2 314; JA 370-2314
• Manufacturer Contact: shama mooman ; safety mgmt dept, quality mgmt; seibu bldg 2, 4th floor 1-11-2; kusunokidai tokorozawa, saitama 359-8-580 ; JA 359-8580
• MDR Report Key: 15802373
• MDR Text Key: 307771454
• Report Number: 8030229-2022-03174
• Device Sequence Number: 1
• Product Code: MHX
• UDI-Device Identifier: 04931921114131
• UDI-Public: 04931921114131
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K102376
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: User Facility
• Reporter Occupation: Biomedical Engineer
• Type of Report: Initial,Followup
• Report Date: 03/16/2023

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: Health Professional
• Device Model Number: CNS-6201A
• Device Catalogue Number: PU-621RA
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 10/17/2022
• Initial Date FDA Received: 11/15/2022
• Supplement Dates Manufacturer Received: 02/16/2023
• Supplement Dates FDA Received: 03/16/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/06/2020
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1