BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    1ML 31GX6MM U-100 INSULIN SYRINGE

    MDR report key: 11702295 · Received April 21, 2021

    Report

    Report Number
    1920898-2021-00441
    Event Type
    Malfunction
    Date Received
    April 21, 2021
    Date of Event
    March 25, 2021
    Report Date
    April 21, 2021
    Manufacturer
    BD MEDICAL - DIABETES CARE
    Product Code
    FMF
    UDI-DI
    00681131138345
    PMA / PMN Number
    K170386
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    H6: INVESTIGATION SUMMARY: NO SAMPLES (INCLUDING PHOTOS) WERE RETURNED THEREFORE THE COMPLAINT COULD NOT BE CONFIRMED AND THE ROOT CAUSE IS UNDETERMINED. A REVIEW OF THE MANUFACTURING RECORDS WAS PERFORMED, AND NO NON-CONFORMANCES WERE RAISED IN ASSOCIATION WITH THIS TYPE OF EVENT FOR THIS LOT. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH# 0223926. ALL INSPECTIONS WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATIONS. THERE WERE ZERO (0) NOTIFICATIONS NOTED THAT PERTAINED TO THE COMPLAINT. THIS WAS MANUFACTURED BEFORE EXPIRATION DATES WERE PRINTED ON PACKAGING.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE 1ML 31GX6MM U-100 INSULIN SYRINGE EXPERIENCED NO LABEL OR MISSING LABEL INFORMATION. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: MATERIAL NO. 328519 BATCH NO. 0223926. PHARMACY REPORTED IF ITEMS EXPIRED - NO EXP DATE ON BOXES. UNOPENED INFORMED OF MANUFACTURING DATES FROM LOT #. PHARMACIST THOUGHT IT WAS RECENT. DATE OF EVENT 03/25/2021.

    Additional Manufacturer Narrative · 1

    MEDICAL DEVICE EXPIRATION DATE: NA. THE CUSTOMER'S ADDRESS IS UNKNOWN:  NEW JERSEY (NJ), USA HAS BEEN USED AS A DEFAULT.  A DEVICE EVALUATION IS ANTICIPATED, BUT HAS NOT YET BEGUN. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE FILED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE 1ML 31GX6MM U-100 INSULIN SYRINGE EXPERIENCED NO LABEL OR MISSING LABEL INFORMATION. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: MATERIAL NO. 328519, BATCH NO. 0223926. PHARMACY REPORTED IF ITEMS EXPIRED - NO EXP DATE ON BOXES. UNOPENED INFORMED OF MANUFACTURING DATES FROM LOT #. PHARMACIST THOUGHT IT WAS RECENT DATE OF EVENT: (B)(6) 2021.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    599648 1ML 31GX6MM U-100 INSULIN SYRINGE PISTON SYRINGE FMF BD MEDICAL - DIABETES CARE 328519 0223926 00681131138345

    Patients

    Seq Age Sex Outcome Treatment
    1