MAUDE Adverse Event Report: NIHON KOHDEN CORPORATION ZM-541PA; TRANSMITTER

Model Number ZM-541PA

Device Problems Overheating of Device (1437); Temperature Problem (3022)

Patient Problems No Consequences Or Impact To Patient (2199); No Known Impact Or Consequence To Patient (2692)

Event Date 11/27/2018

Event Type  malfunction  

Manufacturer Narrative

The customer reported that the transmitter batteries melted the rear casing of this unit.Nihon kohden continues to investigate the reported event.Nihon kohden will submit a supplemental report in accordance with 21 cfr part 803.56 if additional information becomes available.

Event Description

The customer reported that the transmitter batteries melted the rear casing of this unit.No consequence or impact to the patient.

Manufacturer Narrative

Corrected data: d10: device available for evaluation.H3: device evaluated by manufacturer.H10: manufacturer narrative.Additional information: f7: type of report.G7: type of report.H2: if follow-up, what type.H6: event problem and evaluation codes.Manufacturer narrative: investigation result: the device has been in service since 2013, which is over 5 years at the time of reported issue.A review of the device history found no previously reported issues with the unit.Evaluation of the unit found the plastic behind the negative terminal of the middle battery compartment to have been melted.Additionally, the customer had appeared to attempt an incorrect repair of the terminal.Please refer to attached picture.The battery was confirmed to heat up after a few seconds of battery insertion.The root cause is determined to be user error in incorrect repair of the battery terminal.The device was not in use with a patient and there was no reported harm.There is no indication of improper or inadequate device design.

• Brand Name: ZM-541PA
• Type of Device: TRANSMITTER
• Manufacturer (Section D): NIHON KOHDEN CORPORATION; 1-31-4 nishiochia, shinjuku-ku; attn: shama mooman; tokyo, 161-8 560; JA 161-8560
• MDR Report Key: 8187590
• MDR Text Key: 131137891
• Report Number: 8030229-2018-00478
• Device Sequence Number: 1
• Product Code: DRT
• UDI-Device Identifier: 04931921106617
• UDI-Public: 04931921106617
• Combination Product (y/n): N
• PMA/PMN Number: K043517
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional,user faci
• Type of Report: Initial,Followup
• Report Date: 12/17/2018

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: ZM-541PA
• Device Catalogue Number: ZM-541PA
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/28/2018
• Was the Report Sent to FDA?: Yes
• Date Report Sent to FDA: 12/17/2018
• Distributor Facility Aware Date: 11/27/2018
• Device Age: 70 MO
• Event Location: Hospital
• Date Report to Manufacturer: 12/17/2018
• Initial Date Manufacturer Received: 11/27/2018
• Initial Date FDA Received: 12/20/2018
• Supplement Dates Manufacturer Received: 11/27/2018
• Supplement Dates FDA Received: 04/12/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1