FDA Adverse Event Malfunction Summary report: N

BD SAF-T-INTIMA¿ SAFETY SYSTEM WITH REMOVABLE PRN

MDR report key: 13257519 · Received January 14, 2022

Report

Report Number
9610847-2021-00656
Event Type
Malfunction
Date Received
January 14, 2022
Date of Event
December 20, 2021
Report Date
February 1, 2022
Manufacturer
BD INFUSION THERAPY SYSTEMS INC. S.A. DE C.V.
Product Code
FOZ
UDI-DI
30382903833123
PMA / PMN Number
K013800
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CH
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE REPORTED LOT # 1062523 WAS NOT FOUND FOR THE REPORTED CATALOG # 383312. MEDICAL DEVICE EXPIRATION DATE: UNKNOWN. A DEVICE EVALUATION IS ANTICIPATED, BUT HAS NOT YET BEGUN. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE FILED. DEVICE MANUFACTURE DATE: UNKNOWN.

Additional Manufacturer Narrative · 0

THE REPORTED LOT # 1062523 WAS NOT FOUND FOR THE REPORTED CATALOG # 383312. MEDICAL DEVICE EXPIRATION DATE: UNKNOWN. A DEVICE EVALUATION IS ANTICIPATED, BUT HAS NOT YET BEGUN. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE FILED. DEVICE MANUFACTURE DATE: UNKNOWN.

Additional Manufacturer Narrative · 0

INVESTIGATION: OUR QUALITY ENGINEER INSPECTED THE 1 SAMPLE AND 4 PHOTOS SUBMITTED FOR EVALUATION. THE REPORTED ISSUE WAS CONFIRMED UPON INSPECTION OF THE SAMPLES. THE FOREIGN MATTER FOUND WAS MADE OF SILICONE WHICH IS A PART OF OUR MANUFACTURING PROCESS. HOWEVER, SILICONE IS NOT CONSIDERED A FOREIGN MATTER PARTICULATE BASED OFF OUR MANUFACTURING GUIDELINES. SILICONE IS APPLIED TO THE PRODUCT AS A LUBRICANT IN ORDER TO ASSIST IN THE APPLICATION OF THE DEVICE BY THE END USER. DURING MANUFACTURING SOMETIMES EXCESS SILICONE CAN BUILD UP AT THE CATHETER TIP AND FORM A PARTICULATE THAT CAN BE ASSUMED TO BE FOREIGN MATTER. A DEVICE HISTORY RECORD REVIEW SHOWED NO NON-CONFORMANCES ASSOCIATED WITH THIS ISSUE DURING THE PRODUCTION OF THIS BATCH.

Description of Event or Problem · 0

IT WAS REPORTED 3 BD SAF-T-INTIMA¿ SAFETY SYSTEMS WITH REMOVABLE PRNS HAD FOREIGN MATERIAL. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "THE NEEDLE WAS FOUND TO HAVE GLUE WHEN UNPACKING IN THE NEPHROLOGY DEPARTMENT".

Description of Event or Problem · 0

IT WAS REPORTED 3 BD SAF-T-INTIMA¿ SAFETY SYSTEMS WITH REMOVABLE PRNS HAD FOREIGN MATERIAL. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "THE NEEDLE WAS FOUND TO HAVE GLUE WHEN UNPACKING IN THE NEPHROLOGY DEPARTMENT".

Description of Event or Problem · 0

IT WAS REPORTED 3 BD SAF-T-INTIMA¿ SAFETY SYSTEMS WITH REMOVABLE PRNS HAD FOREIGN MATERIAL. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "THE NEEDLE WAS FOUND TO HAVE GLUE WHEN UNPACKING IN THE NEPHROLOGY DEPARTMENT".

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
626049 BD SAF-T-INTIMA¿ SAFETY SYSTEM WITH REMOVABLE PRN INTRAVASCULAR CATHETER FOZ BD INFUSION THERAPY SYSTEMS INC. S.A. DE C.V. 383312 1062523 30382903833123

Patients

Seq Age Sex Outcome Treatment
1 Unknown