FDA Adverse Event Injury Summary report: N

BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM

MDR report key: 12839071 · Received November 18, 2021

Report

Report Number
3014704491-2021-00280
Event Type
Injury
Date Received
November 18, 2021
Date of Event
October 20, 2021
Report Date
November 22, 2021
Manufacturer
BECTON DICKINSON MEDICAL DEVICES CO., LTD. SUZHOU
Product Code
FOZ
PMA / PMN Number
NA
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CH
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

A DEVICE EVALUATION IS ANTICIPATED, BUT HAS NOT YET BEGUN. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE FILED.

Additional Manufacturer Narrative · 0

THE FOLLOWING FIELDS WERE UPDATED DUE TO ADDITIONAL INFORMATION: D.9. DEVICE AVAILABLE FOR EVAL?: YES D.9. RETURNED TO MANUFACTURER ON: 10/26/2021 H.6. INVESTIGATION: A DEVICE HISTORY REVIEW WAS CONDUCTED FOR LOT NUMBER 1111431. OUR RECORDS SHOW THAT THIS IS THE ONLY INSTANCE OF THIS ISSUE OCCURRING IN THIS PRODUCTION BATCH. ACCORDING TO THE SAMPLING PLAN APPLIED FOR PRODUCT PERFORMANCE, THIS LOT WAS ACCEPTED AND RELEASED WITHOUT DEFECTS BEING NOTED DURING THE FINAL ASSEMBLY OR VISUAL INSPECTIONS. ADDITIONALLY A SAMPLE WAS PROVIDED TO OUR FACILITY TO AID IN OUR INVESTIGATION. OUR TEAM OF ENGINEERS HAVE REVIEWED THE DEVICE AND NOTED THAT THE TUBING EXHIBITED A WHITENING OF THE CATHETER TUBING NEAR THE BREAK. THE ISSUE HAS BEEN CONFIRMED. UNFORTUNATELY THE RETURNED DEVICE COULD NOT BE SUBJECT TO FUNCTIONAL TESTING DUE TO THE DAMAGE SUSTAINED; IN LIEU OF THE AFFECTED DEVICE, FUNCTIONAL TESTING WAS PERFORMED ON RETENTION SAMPLES FOR THIS LOT, THE RESULTS OF THESE SHOW THAT THE TESTED UNITS PERFORMED WITHIN PRODUCT SPECIFICATIONS. BASED ON THE WHITENING OF THE TUBING OUR ENGINEERS BELIEVE THAT THE MOST LIKELY ROOT CAUSE FOR THIS EVENT IS RELATED TO THE APPLICATION OF FORCE DURING THE PERIOD OF TIME THAT THE TUBING REMAINED IN THE PATIENT OR DURING THE ATTEMPT TO REMOVE THE TUBING FROM THE PUNCTURE SITE. SEE H.10.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM THE CATHETER BROKE/SEPARATED FROM THE HUB. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: "WHEN THE PEDIATRIC NURSE VISITED THE WARD, HE FOUND THE RETENTION NEEDLE HAD A BROKEN TUBE AND NEEDED TO DO A CT TO CHECK OF THE BROKEN TUBE POSITION. ON 2021-10-26 RECEIVED UPDATE FROM SALES REPRESENTATIVE, EVENT DESCRIPTION UPDATED AS FOLLOWS: THE HOSPITAL CONFIRMED THAT A BROKEN TUBE WAS FOUND IN THE DIGESTIVE TRACT AND DESCRIBED THE CHILD AS HAVING BEEN EXCRETED OUT OF THE BODY.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM THE CATHETER BROKE/SEPARATED FROM THE HUB. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: "WHEN THE PEDIATRIC NURSE VISITED THE WARD, HE FOUND THE RETENTION NEEDLE HAD A BROKEN TUBE AND NEEDED TO DO A CT TO CHECK OF THE BROKEN TUBE POSITION. 2021-10-26 RECEIVED UPDATE FROM SALES REPRESENTATIVE, EVENT DESCRIPTION UPDATED AS FOLLOWS: THE HOSPITAL CONFIRMED THAT A BROKEN TUBE WAS FOUND IN THE DIGESTIVE TRACT AND DESCRIBED THE CHILD AS HAVING BEEN EXCRETED OUT OF THE BODY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1732788 BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM INTRAVASCULAR CATHETER FOZ BECTON DICKINSON MEDICAL DEVICES CO., LTD. SUZHOU 1111431

Patients

Seq Age Sex Outcome Treatment
1 Unknown Other