FDA Adverse Event Malfunction Summary report: N

BD SYRINGE 20ML LUER LOK (PRECISE)

MDR report key: 13063795 · Received December 22, 2021

Report

Report Number
8041187-2021-01069
Event Type
Malfunction
Date Received
December 22, 2021
Date of Event
November 25, 2021
Report Date
January 6, 2022
Manufacturer
BECTON DICKINSON MEDICAL (SINGAPORE)
Product Code
FMF
PMA / PMN Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
HK
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: 12/13/2021. H.6. INVESTIGATION: TWO PHOTOS AND ONE SAMPLE WERE RECEIVED BY OUR QUALITY TEAM FOR EVALUATION. FROM THE PHOTOS, THE TEAM OBSERVED A SOLID PIECE OF FOREIGN MATTER INSIDE THE SYRINGE PRODUCT. UPON INSPECTION OF THE RECEIVED SAMPLE, THE TEAM OBSERVED A PIECE OF BROKEN PLUNGER INSIDE THE BARREL. A REVIEW OF THE INTERNAL MANUFACTURING DEVICE RECORDS AND RAW MATERIAL HISTORY FILES FOR THE REPORTED LOT NUMBER WAS PERFORMED AND NO RECORDED QUALITY PROBLEMS OR REJECTIONS TO THIS INCIDENT WERE FOUND. THIS NONCONFORMANCE COULD HAVE OCCURRED AT THE ASSEMBLY MACHINE. WHEN THERE IS A MOLDED PLUNGER JAMMED AT THE ASSEMBLY DIAL, THE MACHINE DIALS ARE UNABLE TO TURN AND THE PRODUCTION TECHNICIAN WILL REMOVE THE TOP THUMB-PRESS OF THE MOLDED PLUNGER WITH A CUTTER, THEN SLOWLY ADJUST THE DIALS UNTIL THE JAMMED PLUNGER IS FREE FROM THE TIGHT SPOT. DURING THE CUTTING, THE BROKEN PIECE COULD HAVE FLOWN OFF AND DROP INSIDE THE BARREL.

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.

Description of Event or Problem · 0

IT WAS REPORTED THE BD SYRINGE 20ML LUER LOK (PRECISE) HAD FOREIGN MATTER IN SYRINGE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: THE CUSTOMER COMPLAINED THAT FOREIGN BODY WAS FOUND INSIDE THE SYRINGE.

Description of Event or Problem · 0

IT WAS REPORTED THE THE BD SYRINGE 20ML LUER LOK (PRECISE) HAD FOREIGN MATTER IN SYRINGE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: THE CUSTOMER COMPLAINED THAT FOREIGN BODY WAS FOUND INSIDE THE SYRINGE.

Description of Event or Problem · 0

IT WAS REPORTED THE BD SYRINGE 20ML LUER LOK (PRECISE) HAD FOREIGN MATTER IN SYRINGE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: THE CUSTOMER COMPLAINED THAT FOREIGN BODY WAS FOUND INSIDE THE SYRINGE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1959598 BD SYRINGE 20ML LUER LOK (PRECISE) PISTON SYRINGE FMF BECTON DICKINSON MEDICAL (SINGAPORE) 0359194

Patients

Seq Age Sex Outcome Treatment
1 Unknown