FDA Adverse Event Malfunction Summary report: N

BD ECLIPSE¿ NEEDLE W/ DETACHABLE 1 ML BD LUER-LOK¿ SYRINGE

MDR report key: 13389484 · Received January 28, 2022

Report

Report Number
8041187-2022-00049
Event Type
Malfunction
Date Received
January 28, 2022
Date of Event
January 10, 2022
Report Date
April 4, 2022
Manufacturer
BECTON DICKINSON MEDICAL (SINGAPORE)
Product Code
FMI
UDI-DI
30382903057802
PMA / PMN Number
K161170
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 MEDICAL DEVICE TYPES REPORTED TO BE INVOLVED. THE INFORMATION FOR THE ADDITIONAL DEVICE TYPE IS AS FOLLOWS: MEDICAL DEVICE TYPE: FMF. COMMON DEVICE NAME: PISTON SYRINGE. PMA / 510(K)#: K941562. 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

THERE WERE MULTIPLE MEDICAL DEVICE TYPES REPORTED TO BE INVOLVED. THE INFORMATION FOR THE ADDITIONAL DEVICE TYPE IS AS FOLLOWS: MEDICAL DEVICE TYPE: FMF. COMMON DEVICE NAME: PISTON SYRINGE. PMA / 510(K)#: K941562. 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: 14-MAR-2022. H6: INVESTIGATION SUMMARY TWO SAMPLES WERE RECEIVED BY OUR QUALITY TEAM FOR EVALUATION. AS THE SAMPLE IS MANUFACTURED AT BD CANAAN, FUNCTIONAL TESTING WAS NOT PERFORMED BY TUAS AS TO NOT DESTROY THE SAMPLES. 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. THE QUALITY TEAM AT BD CANAAN HAS PERFORMED A SUPPLEMENTAL INVESTIGATION ON THE RETURNED SAMPLES. IN THE PHOTO, A 1 ML LUER-LOK SYRINGE CAN BE SEEN WITH AN ECLIPSE NEEDLE ATTACHED. THE PLUNGER ROD IS DRAWN OUT TO THE 0.6 ¿ 0.7 ML AREA OF THE SYRINGE. THE REPORTED DEFECT COULD NOT BE OBSERVED IN THE RETURNED PHOTO. THE PHYSICAL SAMPLES WERE RECEIVED IN AN UNSEALED BLISTER-PACKS. UPON EXERCISING BOTH PLUNGER RODS, THEY WERE SMOOTH TO DRAW, AND THE REPORTED DEFECT COULD NOT BE IDENTIFIED OR CONFIRMED IN THE SAMPLES RECEIVED. AS THE DEFECT COULD NOT BE CONFIRMED, A ROOT CAUSE COULD NOT BE DETERMINED. H3 OTHER TEXT : SEE H10.

Additional Manufacturer Narrative · 0

H.6. INVESTIGATION: NO PHOTOS OR SAMPLES WERE RECEIVED BY OUR QUALITY TEAM FOR EVALUATION THEREFORE THE FAILURE MODE COULD NOT BE VERIFIED. 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. A DEVICE HISTORY REVIEW WAS ALSO PERFORMED BY BD CANAAN, WHERE THE SYRINGE PART WAS MANUFACTURED AND NO RECORDED QUALITY PROBLEMS OR REJECTIONS TO THIS INCIDENT WERE FOUND FOR THE REPORTED LOT NUMBER. BASED ON THE QUALITY TEAM'S INVESTIGATION, THE ROOT CAUSE OF THIS INCIDENT CANNOT BE DETERMINED. H3 OTHER TEXT : SEE H.10.

Description of Event or Problem · 0

IT WAS REPORTED THAT 2 BD ECLIPSE¿ NEEDLE W/ DETACHABLE 1 ML BD LUER-LOK¿ SYRINGE HAD PLUNGERS THAT WERE DIFFICULT TO MOVE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: PLUNGER IS HARD TO PUSH.

Description of Event or Problem · 0

IT WAS REPORTED THAT 2 BD ECLIPSE¿ NEEDLE W/ DETACHABLE 1 ML BD LUER-LOK¿ SYRINGE HAD PLUNGERS THAT WERE DIFFICULT TO MOVE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: PLUNGER IS HARD TO PUSH.

Description of Event or Problem · 0

IT WAS REPORTED THAT 2 BD ECLIPSE¿ NEEDLE W/ DETACHABLE 1 ML BD LUER-LOK¿ SYRINGE HAD PLUNGERS THAT WERE DIFFICULT TO MOVE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: PLUNGER IS HARD TO PUSH.

Description of Event or Problem · 0

IT WAS REPORTED THAT 2 BD ECLIPSE¿ NEEDLE W/ DETACHABLE 1 ML BD LUER-LOK¿ SYRINGE HAD PLUNGERS THAT WERE DIFFICULT TO MOVE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: PLUNGER IS HARD TO PUSH.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1736150 BD ECLIPSE¿ NEEDLE W/ DETACHABLE 1 ML BD LUER-LOK¿ SYRINGE HYPODERMIC SINGLE LUMEN NEEDLE FMI BECTON DICKINSON MEDICAL (SINGAPORE) 305780 1204100 30382903057802

Patients

Seq Age Sex Outcome Treatment
1 Unknown