MAUDE Adverse Event Report: NIHON KOHDEN CORPORATION NEUROFAX; ELECTROENCEPHALOGRAPH

Model Number	EEG-1200A
Medical Device Problem Code	Output Problem (3005)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/09/2024
Type of Reportable Event	Malfunction
Event or Problem Description
The customer reported that the exams listed have incorrect medical record numbers.They can edit the medical records number, and it changes, and then in 24 hours it changes back.It appears that when you click to check for accuracy the customer does not have rights to the folder to make the changes.Not in patient use.
Additional Manufacturer Narrative
The customer reported that the exams listed have incorrect medical record numbers.They can edit the medical records number, and it changes, and then in 24 hours it changes back.It appears that when you click to check for accuracy the customer does not have rights to the folder to make the changes.Not in patient use.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.The following fields contains no information (ni), as attempts to obtain information were made, but the information was not provided.D4 serial number h4 device manufacturer date attempt #1 (b)(6)/2024 emailed customer via microsoft outlook for all items under the no information section.No reply was received.Attempt #2 (b)(6)2024 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 and device information as requested.Eeg review unit model: eeg-1200 review unit sn: na.
Additional Manufacturer Narrative
Details of the complaint: the customer reported that the exams listed have incorrect medical record numbers.They can edit the medical records number, and it changes, and then in 24 hours it changes back.It appears that when you click to check for accuracy the customer does not have rights to the folder to make the changes.Not in patient use.Investigation conclusion: the nihon kohden neurology engineering service team (nk nes) checked the customer database and found that a database registration file was recreated and not getting deleted normally as part of the sub to main database process whenever neuroworkbench (nwb) was launched.Nk nes used an installation tool to keep the extra file from being created as a workaround solution.A definitive root cause could not be determined from nk nes' review of the customer database, but a temporary solution was created for the customer.Possible cause may be a software deficiency with the database management tools used with nwb.A review of the customer's complaint history does not show recurrence or other similar complaints.The following fields contains no information (ni), as attempts to obtain information were made, but the information was not provided.D4 serial number h4 device manufacturer date attempt #1: (b)(6) 2024 emailed customer via microsoft outlook for all items under the no information section.No reply was received.Attempt #2 (b)(6) 2024 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 and device information as requested.Eeg review unit.Model: eeg-1200 review unit sn: na.Corrected information: d1 brand name was corrected from eeg-1200a to neurofax.
Event or Problem Description
The customer reported that the exams listed have incorrect medical record numbers.They can edit the medical records number, and it changes, and then in 24 hours it changes back.It appears that when you click to check for accuracy the customer does not have rights to the folder to make the changes.Not in patient use.
Additional Manufacturer Narrative
Details of the complaint: the customer reported that the exams listed have incorrect medical record numbers.They can edit the medical records number, and it changes, and then in 24 hours it changes back.It appears that when you click to check for accuracy the customer does not have rights to the folder to make the changes.Not in patient use.Investigation conclusion: the nihon kohden neurology engineering service team (nk nes) checked the customer database and found that a database registration file was recreated and not getting deleted normally as part of the sub to main database process whenever neuroworkbench (nwb) was launched.Nk nes used an installation tool to keep the extra file from being created as a workaround solution.A definitive root cause could not be determined from nk nes' review of the customer database, but a temporary solution was created for the customer.Possible cause may be a software deficiency with the database management tools used with nwb.A review of the customer's complaint history does not show recurrence or other similar complaints.The following fields contains no information (ni), as attempts to obtain information were made, but the information was not provided.D4 serial number.H4 device manufacturer date.Attempt #1: (b)(6) 2024 emailed customer via microsoft outlook for all items under the no information section.No reply was received.Attempt #2: (b)(6) 2024 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 and device information as requested.Eeg review unit: model: eeg-1200 review unit: sn: na.Corrected information: d1 brand name was corrected from eeg-1200a to neurofax d4 unique identifier (udi) corrected from (b)(4).
Event or Problem Description
The customer reported that the exams listed have incorrect medical record numbers.They can edit the medical records number, and it changes, and then in 24 hours it changes back.It appears that when you click to check for accuracy the customer does not have rights to the folder to make the changes.Not in patient use.

• Brand Name: NEUROFAX
• Common Device Name: ELECTROENCEPHALOGRAPH
• 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 ; seibu bldg 2, 4th floor 1-11-2; kusunokidai tokorozawa, saitama 359-8-580 ; JA 359-8580
• MDR Report Key: 19282102
• Report Number: 8030229-2024-04287
• Device Sequence Number: 6358497
• Product Code: OLT
• UDI-Device Identifier: 04931921110904
• UDI-Public: (01)04931921110904
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: K080546
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 01/23/2025

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
• Operator of Device: Health Professional
• Device Model Number: EEG-1200A
• Device Catalogue Number: EEG-1200A
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/09/2024
• Supplement Date Received by Manufacturer: 01/14/2025; 01/14/2025
• Initial Report FDA Received Date: 05/09/2024
• Supplement Report FDA Received Date: 01/21/2025; 01/23/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: EEG REVIEW UNIT; EEG REVIEW UNIT; EEG REVIEW UNIT
• Patient Sex: Unknown