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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: NIHON KOHDEN CORPORATION GF-210RA; MULTI-GAS UNIT

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NIHON KOHDEN CORPORATION GF-210RA; MULTI-GAS UNIT Back to Search Results
Model Number GF-210RA
Device Problem Output Problem (3005)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 11/23/2021
Event Type  malfunction  
Manufacturer Narrative
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 biomedical engineer reported that they are having an error populate on the multigas unit stating a "device error." it is intermittent, and it disappears once they reboot it.However, one of the doctors has complained that a very loud screeching noise comes from the unit almost as if a screw is loose inside.They called back when they attempted to do an operational check on the unit, the gas monitor did not power on.Tech support (ts) informed them that in order for the gas bench to turn on, it must sense a connection with a bedside monitor (bsm) via the interface (if) cable.They stated that they would have to locate a connection if cable, and connect the gas bench to a bsm.No patient harm was reported.
 
Manufacturer Narrative
Details of the complaint: the biomedical engineer reported that they are having an error populate on the multigas unit stating a "device error." it is intermittent, and it disappears once they reboot it.However, one of the doctors has complained that a very loud screeching noise comes from the unit almost as if a screw is loose inside.They called back when they attempted to do an operational check on the unit, the gas monitor did not power on.No patient harm was reported.Service requested / performed: sensor was replaced.Investigation conclusion: the root cause is determined to be component failure: sensor needed replacement.Sensor is a replaceable component, where the longevity is dependent upon the following factors: instrument and parts must undergo regular maintenance inspection at least every 6 months.If stored for extended periods without being used, make sure prior to operation that the instrument is in perfect operating condition.Water trap should be replaced every 4 weeks or as indicated on the device.Ensuring the environment is optimal as described in the operator's manual.When the issue is not duplicated during evaluation, the possible causes are related to the appropriate connection of the air tubes, connectors, and watertrap.The root cause of the reported issue is attributable to the state of wear-components such as watertrap, connectors, sampling line, and/or device damage.The following fields are not applicable (na) to the mdr report: b2 d4 lot number & expiration d6a - d6b d7b f1 - f14 g4 device bla number g5 g7 h7 h9 the following fields contains no information (ni), as attempts to obtain information were made, but not provided.A2 - a6 b6 - b7 attempt #1 12/09/2021 emailed customer via microsoft outlook for all items under the no information section.No reply was received.Attempt #2 12/20/2021 emailed customer via microsoft outlook for all items under the no information section.No reply was received.Attempt #3 12/21/2021 emailed customer via microsoft outlook for all items under the no information section.The customer responded back with complaint details, but they did not provide the patient information as requested.Additional device information: d10: concomitant medical device: the following device(s) were being used in conjunction with the multigas unit, but model and serial number information was noted as no information (ni), as attempts to obtain information were made but information was not provided.Attempt #1 12/09/2021 emailed customer via microsoft outlook for all items under the no information section.No reply was received.Attempt #2 12/20/2021 emailed customer via microsoft outlook for all items under the no information section.No reply was received.Attempt #3 12/21/2021 emailed customer via microsoft outlook for all items under the no information section.The customer responded back with complaint details, but they did not provide the additional device information as requested.Bedside monitor model: ni.Sn: ni.Additional information: b4 date of this report.D9 device available for evaluation.G3 date received by manufacturer.G6 type of report.H2 if follow-up, what type? h3 device evaluated by manufacturer.H6 event problem and evaluation codes.H10 additional manufacturer narrative.
 
Event Description
The biomedical engineer reported that they are having an error populate on the multigas unit stating a "device error." it is intermittent, and it disappears once they reboot it.However, one of the doctors has complained that a very loud screeching noise comes from the unit almost as if a screw is loose inside.They called back when they attempted to do an operational check on the unit, the gas monitor did not power on.Tech support (ts) informed them that in order for the gas bench to turn on, it must sense a connection with a bedside monitor (bsm) via the interface (if) cable.They stated that they would have to locate a connection if cable, and connect the gas bench to a bsm.No patient harm was reported.
 
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Brand Name
GF-210RA
Type of Device
MULTI-GAS UNIT
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 Key13146151
MDR Text Key285826351
Report Number8030229-2022-02328
Device Sequence Number1
Product Code CCK
UDI-Device Identifier04931921106891
UDI-Public04931921106891
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K110594
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type User Facility
Reporter Occupation Biomedical Engineer
Type of Report Initial,Followup
Report Date 04/04/2022
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 NumberGF-210RA
Device Catalogue NumberGF-210RA
Was Device Available for Evaluation? Device Returned to Manufacturer
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 12/07/2021
Initial Date FDA Received01/03/2022
Supplement Dates Manufacturer Received03/21/2022
Supplement Dates FDA Received04/04/2022
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured12/19/2019
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse
Patient Sequence Number1
Treatment
BEDSIDE MONITOR; BEDSIDE MONITOR
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