BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    NEEDLE 23X1 RB

    MDR report key: 11397204 · Received March 2, 2021

    Report

    Report Number
    1911916-2021-00174
    Event Type
    Malfunction
    Date Received
    March 2, 2021
    Date of Event
    February 1, 2021
    Report Date
    February 23, 2021
    Manufacturer
    BD MEDICAL (BD WEST) MEDICAL SURGICAL
    Product Code
    FMI
    UDI-DI
    30382903051459
    PMA / PMN Number
    K021475
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    INVESTIGATION SUMMARY: A DEVICE HISTORY RECORD REVIEW WAS COMPLETED BY OUR QUALITY ENGINEER TEAM FOR PROVIDED MATERIAL NUMBER 305145 AND LOT NUMBER 9193563. THE REVIEW DID NOT REVEAL ANY DETECTED ABNORMALITIES DURING THE PRODUCTION PROCESS THAT COULD HAVE CONTRIBUTED TO THIS DEFECT AND ALL QUALITY TESTS WERE FOUND TO BE WITHIN SPECIFICATION. AS A SAMPLE WAS UNAVAILABLE FOR RETURN, A THOROUGH SAMPLE INVESTIGATION COULD NOT BE COMPLETED. BASED ON THE INVESTIGATION RESULTS, AN EXACT CAUSE FOR THIS INCIDENT COULD NOT BE IDENTIFIED. FURTHER ACTION HAS NOT BEEN DETERMINED NECESSARY AT THIS TIME. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. OUR QUALITY TEAM REGULARLY REVIEWS THE COLLECTED DATA FOR IDENTIFICATION OF EMERGING TRENDS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE NEEDLE 23X1 RB WAS "RUSTY". THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "1 OF THE NEEDLES IN THE BOX IS RUSTY."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    295792 NEEDLE 23X1 RB HYPODERMIC SINGLE LUMEN NEEDLE FMI BD MEDICAL (BD WEST) MEDICAL SURGICAL 305145 9193563 30382903051459

    Patients

    Seq Age Sex Outcome Treatment
    1