FDA Adverse Event Malfunction Summary report: N

BD ULTRA-FINE¿ NANO¿ PEN NEEDLE

MDR report key: 13226746 · Received January 11, 2022

Report

Report Number
9616656-2021-01638
Event Type
Malfunction
Date Received
January 11, 2022
Date of Event
December 15, 2021
Report Date
February 24, 2022
Manufacturer
BECTON DICKINSON AND CO.
Product Code
FMI
UDI-DI
00382903205509
PMA / PMN Number
K162516
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
PHARMACIST
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. 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: D10: DEVICE AVAILABLE FOR EVAL YES, D10: RETURNED TO MANUFACTURER ON: 2022-02-07. H6: INVESTIGATION SUMMARY: CUSTOMER RETURNED (28) UNUSED 32GX4MM BD PEN NEEDLES FROM LOT# 1103568. THE CUSTOMER REPORTED LEAKAGE WHEN TAKING INJECTION, WELTS AT THE INJECTION SITE, AND UNCERTAINTY OF GETTING DOSAGE. THE RETURNED PEN NEEDLES WERE EXAMINED, THEN TESTED FOR FLOW USING A TEST PEN INJECTOR, AND IT WAS OBSERVED THAT ALL 28 SAMPLES WERE ABLE TO EXPEL PROPERLY; NO LEAKAGE WAS OBSERVED. A LOT HISTORY REVIEW WAS CARRIED OUT AND NO RELATED NON CONFORMANCES WERE RAISED IN ASSOCIATION WITH THIS PACKAGED LOT CONCLUDING ALL INSPECTIONS WERE PERFORMED AS PER THE APPLICABLE OPERATIONS AND MET QC SPECIFICATIONS. BD WAS NOT ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE ROOT CAUSE CANNOT BE DETERMINED AT THIS TIME AS THE ISSUE IS UNCONFIRMED. H3 OTHER TEXT : SEE H10.

Additional Manufacturer Narrative · 0

THE FOLLOWING FIELDS WERE UPDATED DUE TO ADDITIONAL INFORMATION: H5: IMDRF ANNEX E GRID: E2403, E1720. H5: IMDRF ANNEX F GRID: F24, F11. INVESTIGATION SUMMARY: NO SAMPLES (INCLUDING PHOTOS) WERE RETURNED THEREFORE THE COMPLAINT COULD NOT BE CONFIRMED AND THE ROOT CAUSE IS UNDETERMINED. A LOT HISTORY REVIEW WAS CARRIED OUT AND NO RELATED NON CONFORMANCES WERE RAISED IN ASSOCIATION WITH THIS PACKAGED LOT CONCLUDING ALL INSPECTIONS WERE PERFORMED AS PER THE APPLICABLE OPERATIONS AND MET QC SPECIFICATIONS. H3 OTHER TEXT : SEE H10.

Description of Event or Problem · 0

IT WAS REPORTED THAT 1 BD ULTRA-FINE¿ NANO¿ PEN NEEDLE LEAKED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER : THE CONSUMER REPORTED LEAKAGE WHEN TAKING INJECTION. DATE OF EVENT : UNKNOWN. SAMPLES : AVAILABLE.

Description of Event or Problem · 0

IT WAS REPORTED THAT 1 BD ULTRA-FINE¿ NANO¿ PEN NEEDLE LEAKED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER : THE CONSUMER REPORTED LEAKAGE WHEN TAKING INJECTION. DATE OF EVENT : UNKNOWN. SAMPLES : AVAILABLE.

Description of Event or Problem · 0

IT WAS REPORTED THAT 1 BD ULTRA-FINE¿ NANO¿ PEN NEEDLE LEAKED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER : THE CONSUMER REPORTED LEAKAGE WHEN TAKING INJECTION. DATE OF EVENT : UNKNOWN. SAMPLES : AVAILABLE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
655227 BD ULTRA-FINE¿ NANO¿ PEN NEEDLE HYPODERMIC SINGLE LUMEN NEEDLE FMI BECTON DICKINSON AND CO. 320550 1103568 00382903205509

Patients

Seq Age Sex Outcome Treatment
1 Unknown