FDA Adverse Event Malfunction Summary report: N

BD ECLIPSE¿ NEEDLE

MDR report key: 13374013 · Received January 27, 2022

Report

Report Number
8041187-2022-00047
Event Type
Malfunction
Date Received
January 27, 2022
Date of Event
January 11, 2022
Report Date
March 16, 2022
Manufacturer
BECTON DICKINSON MEDICAL (SINGAPORE)
Product Code
FMI
UDI-DI
30382903057826
PMA / PMN Number
SEE H.10.
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TW
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THERE WERE MULTIPLE PMA / 510(K)#S REPORTED TO BE INVOLVED. THE INFORMATION FOR EACH 510(K) NUMBER IS AS FOLLOWS: PMA / 510(K)#: K980987 (SYRINGE). PMA / 510(K)#: K161170 (NEEDLE). 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: 2022-03-03. H6: INVESTIGATION SUMMARY: ONE PHOTO AND ONE SYRINGE WERE RECEIVED BY OUR QUALITY TEAM FOR EVALUATION. FROM THE PHOTO, LEAKAGE AT THE CONNECTION BETWEEN THE SYRINGE TIP AND AN UNKNOWN DEVICE. THE RETURNED SYRINGE WAS ATTACHED TO AN UNKNOWN MEDICAL DEVICE. SIGNS OF LIQUID CAN BE SEEN INSIDE THE SYRINGE BARREL AND INSIDE THE COLLAR THREAD. THE SYRINGE WAS SUBJECTED TO VISUAL INSPECTION TO CHECK FOR DAMAGE SYRINGE TIP AND COLLAR THREAD. NO DAMAGE WAS OBSERVED ON THE SYRINGE TIP AND COLLAR THREAD WERE OBSERVED. AFTER DECONTAMINATION, THE SYRINGE SAMPLE WAS SUBJECTED TO LEAK TESTING AND PASSED. 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. BASED ON THE QUALITY TEAM'S INVESTIGATION, THE ROOT CAUSE OF THIS INCIDENT CANNOT BE DETERMINED.

Additional Manufacturer Narrative · 0

THERE WERE MULTIPLE PMA / 510(K)#S REPORTED TO BE INVOLVED. THE INFORMATION FOR EACH 510(K) NUMBER IS AS FOLLOWS: PMA / 510(K)#: K980987 (SYRINGE). PMA / 510(K)#: K161170 (NEEDLE). 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 SUMMARY: ONE PHOTO WAS RECEIVED BY OUR QUALITY TEAM FOR EVALUATION. FROM THE PHOTO, LEAKAGE WAS OBSERVED AT THE CONNECTION BETWEEN THE SYRINGE TIP AND AN UNKNOWN DEVICE. 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. AS THE ACTUAL SAMPLE WAS NOT RETURNED TO FURTHER EXAMINE THE SYRINGE TIP, THE ROOT CAUSE COULD NOT BE DETERMINED.

Description of Event or Problem · 0

IT WAS REPORTED BD ECLIPSE¿ NEEDLE HAD LEAKAGE ISSUES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "LEAKAGE"

Description of Event or Problem · 0

IT WAS REPORTED BD ECLIPSE¿ NEEDLE HAD LEAKAGE ISSUES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "LEAKAGE."

Description of Event or Problem · 0

IT WAS REPORTED BD ECLIPSE¿ NEEDLE HAD LEAKAGE ISSUES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "LEAKAGE"

Description of Event or Problem · 0

IT WAS REPORTED BD ECLIPSE¿ NEEDLE HAD LEAKAGE ISSUES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "LEAKAGE."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
592444 BD ECLIPSE¿ NEEDLE HYPODERMIC SINGLE LUMEN NEEDLE FMI BECTON DICKINSON MEDICAL (SINGAPORE) 305782 1204165 30382903057826

Patients

Seq Age Sex Outcome Treatment
1 Unknown