BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM

    MDR report key: 13091023 · Received December 27, 2021

    Report

    Report Number
    3014704491-2021-00393
    Event Type
    Malfunction
    Date Received
    December 27, 2021
    Date of Event
    November 9, 2021
    Report Date
    January 3, 2022
    Manufacturer
    BECTON DICKINSON MEDICAL DEVICES CO., LTD. SUZHOU
    Product Code
    FOZ
    PMA / PMN Number
    NA
    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

    H6: INVESTIGATION: A DEVICE HISTORY REVIEW WAS CONDUCTED FOR LOT NUMBER 1203278. 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. A SAMPLE COULD NOT BE OBTAINED FOR EVALUATION AND TESTING; 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. UNFORTUNATELY WITHOUT THE ABILITY TO INVESTIGATE THE AFFECTED UNIT OUR QUALITY ENGINEERS WERE UNABLE TO DETERMINE THE ROOT CAUSE FOR THIS COMPLAINT.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE PRN WAS SEPARATED FROM THE ADAPTER WHILE USING BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM. THERE WAS NO REPORT OF PATIENT IMPACT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM (B)(6) TO ENGLISH: "ON THE FIRST DAY OF THE INDWELLING NEEDLE, THE HEPARIN CAP WAS AUTOMATICALLY DISCONNECTED FROM THE INTERFACE WHEN THE TUBE WAS FLUSHED AND SEALED AT THE END OF THE INFUSION."

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE PRN WAS SEPARATED FROM THE ADAPTER WHILE USING BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM. THERE WAS NO REPORT OF PATIENT IMPACT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM CHINESE TO ENGLISH: "ON THE FIRST DAY OF THE INDWELLING NEEDLE, THE HEPARIN CAP WAS AUTOMATICALLY DISCONNECTED FROM THE INTERFACE WHEN THE TUBE WAS FLUSHED AND SEALED AT THE END OF THE INFUSION."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1984721 BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM INTRAVASCULAR CATHETER FOZ BECTON DICKINSON MEDICAL DEVICES CO., LTD. SUZHOU 1203278

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown