BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SYRINGE 1.0ML 31GA 6MM 10BAG 500CS

    MDR report key: 10107535 · Received June 2, 2020

    Report

    Report Number
    1920898-2020-00603
    Event Type
    Malfunction
    Date Received
    June 2, 2020
    Date of Event
    May 14, 2020
    Report Date
    May 18, 2020
    Manufacturer
    BD MEDICAL - DIABETES CARE
    Product Code
    FMF
    UDI-DI
    00382903249121
    PMA / PMN Number
    K170386
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. INVESTIGATION SUMMARY: LEVEL A INVESTIGATION COMPLAINT EVALUATION / COMPLAINT HISTORY CHECK FOR THE EVENT(S) THAT OCCURRED. SEVERITY: S_1__; OCCURRENCE: A COMPLAINT HISTORY CHECK WAS PERFORMED AND THIS IS THE 1ST RELATED COMPLAINT FOR NEEDLE SEPARATES FROM VIAL AND DIFFICULT/UNABLE TO OPERATE ON LOT # 9140729. INVESTIGATION SUMMARY: NO SAMPLES (INCLUDING PHOTOS) WERE RETURNED THEREFORE THE COMPLAINT COULD NOT BE CONFIRMED AND THE ROOT CAUSE IS UNDETERMINED. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. IF SAMPLES ARE RECEIVED IN THE FUTURE THE COMPLAINT WILL BE REOPENED FOR FURTHER INVESTIGATION. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH# 9140729. ALL INSPECTIONS WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATIONS. THERE WERE ZERO (0) NOTIFICATIONS NOTED THAT PERTAINED TO THE COMPLAINT. INVESTIGATION CONCLUSION: AS NO SAMPLES AND/OR PHOTO(S) WERE RECEIVED THE INVESTIGATION CONCLUDED: UNCONFIRMED: BD WAS NOT ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE AS NO SAMPLES OR PHOTOS WERE RETURNED COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. INFORMATION WILL BE CAPTURED ON TREND REPORTS AND MONITORED MONTHLY. OUR BUSINESS TEAM REGULARLY REVIEWS THE COLLECTED DATA FOR IDENTIFICATION OF EMERGING TRENDS. ROOT CAUSE DESCRIPTION: ROOT CAUSE CANNOT BE DETERMINED AT THIS TIME AS THE ISSUE IS UNCONFIRMED AS NO SAMPLES OR PHOTOS WERE RETURNED. RATIONALE: BASED ON THE INVESTIGATION, NO ADDITIONAL INVESTIGATION AND NO CAPA IS REQUIRED AT THIS TIME.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT SYRINGE 1.0ML 31GA 6MM 10BAG 500CS WAS DIFFICULT TO OPERATE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "CONSUMER REPORTS WHILE DRAWING INSULIN FROM VIAL THE NEEDLE ATTACHED TO SYRINGE REMOVES FROM VIAL CONSUMER REPORTED WHEN DRAWING INSULIN FROM VIAL THE NEEDLE STILL ATTACHED TO SYRINGE REMOVES FROM VIAL. LOT #: 9140724, CATALOG#: 324912, DATE OF EVENT: UNKNOWN, SAMPLES STATUS DISCARD. CONSUMER MOSTLY WANTED TO INFORM THIS HAS HAPPENED. HE IS (B)(6) AND INJECTING WITH BD SYRINGES FOR 23 YEARS. HAVING ISSUES HOLDING THE NEEDLE IN VIAL WHILE DRAWING. I AM SENDING A MAGNI GUIDE FOR HOPEFUL ASSISTANCE. CONSUMER WOULD LIKE BD TO MAKE THE SYRINGE WIDER OR WITH A GRIP AROUND 10-20 UNIT MARKER."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    576228 SYRINGE 1.0ML 31GA 6MM 10BAG 500CS PISTON SYRINGE FMF BD MEDICAL - DIABETES CARE 324912 9140729 00382903249121

    Patients

    Seq Age Sex Outcome Treatment
    1 88 YR Other