MAUDE Adverse Event Report: NKUS LAB RNS-9703-024; REMOTE NETWORK STATION

Model Number	RNS-9703-024
Medical Device Problem Codes	No Display/Image (1183); Output Problem (3005)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/13/2015
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The biomedical engineer (bme) reported that the rns in 36 north had a black display even after resetting.They tried testing the hd cable on another rns, and it worked, but not on this device.They were provided with an exchanged device, since other troubleshooting efforts were not successful.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 or Problem Description
The biomedical engineer (bme) reported that the rns in 36 north had a black display even after resetting.

• Brand Name: RNS-9703-024
• Common Device Name: REMOTE NETWORK STATION
• Manufacturer (Section D): NKUS LAB; 5 jenner, suite 180; attn.: susan shadley; irvine CA 92618
• Manufacturer (Section G): NKUS LAB; 5 jenner, suite 180; attn.: susan shadley; irvine CA 92618
• Manufacturer Contact: susan shadley ; 5 jenner, suite 180; attn.: susan shadley; irvine, CA 92618 ; 9492687708
• MDR Report Key: 5501401
• Report Number: 2032233-2015-00080
• Device Sequence Number: 16820823
• Product Code: MHX
• UDI-Device Identifier: 00851725007016
• UDI-Public: 00851725007016
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: K023475
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Initial Reporter Occupation: Biomedical Engineer
• Type of Report: Initial,Followup
• Report Date (Section B): 03/15/2016

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 Model Number: RNS-9703-024
• Device Catalogue Number: RNS-9703-024
• 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: 04/13/2015
• Supplement Date Received by Manufacturer: 04/13/2015
• Initial Report FDA Received Date: 03/15/2016
• Supplement Report FDA Received Date: 03/15/2016
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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
• Patient Sex: Unknown