FDA Adverse Event Malfunction Summary report: N

BD CANNULA INTERLINK THREADED LOCK

MDR report key: 13403002 · Received January 31, 2022

Report

Report Number
1213809-2022-00025
Event Type
Malfunction
Date Received
January 31, 2022
Date of Event
December 27, 2021
Report Date
February 16, 2022
Manufacturer
BECTON DICKINSON MEDICAL SYSTEMS
Product Code
FMI
UDI-DI
00382903033690
PMA / PMN Number
K011858
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
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

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: 2022-02-04. H6: INVESTIGATION SUMMARY: FOUR PICTURES AND ONE SAMPLE OF A THREAD LOCK COMPONENT (P/N 303369) FROM BATCH # 1082816 WERE RECEIVED AND EVALUATED. NO BLOCKAGE OBSERVED FROM PHOTOS AND PHYSICAL SAMPLE RECEIVED. SINCE THE REPORTED DEFECT WAS NOT IDENTIFIED IN THE SAMPLES RECEIVED, A POTENTIAL ROOT CAUSE COULD NOT BE DEFINED. A DEVICE HISTORY RECORD REVIEW SHOWED NO REJECTED INSPECTIONS OR QUALITY ISSUES DURING THE PRODUCTION OF THE PROVIDED LOT NUMBER THAT COULD HAVE CONTRIBUTED TO THE REPORTED DEFECT.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD CANNULA INTERLINK THREADED LOCK, THE DEVICE EXPERIENCED FLOW ISSUES. THIS EVENT OCCURRED 2 TIMES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: THIS IS A REPORT ABOUT A FLOW ISSUE. ACCORDING TO THE CUSTOMER'S VERBATIM REPORT, THE HCP CONNECTED A THREADED LOCK CANNULA TO THE INJECTION SITE OF A2N3374-ZBA BUT THE FLUID DIDN'T FLOW. THE HCP THEN USED ANOTHER THREADED LOCK CANNULA BUT THE FLUID STILL DIDN¿T FLOW.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD CANNULA INTERLINK THREADED LOCK, THE DEVICE EXPERIENCED FLOW ISSUES. THIS EVENT OCCURRED 2 TIMES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: THIS IS A REPORT ABOUT A FLOW ISSUE. ACCORDING TO THE CUSTOMER'S VERBATIM REPORT, THE HCP CONNECTED A THREADED LOCK CANNULA TO THE INJECTION SITE OF A2N3374-ZBA BUT THE FLUID DIDN'T FLOW. THE HCP THEN USED ANOTHER THREADED LOCK CANNULA BUT THE FLUID STILL DIDN¿T FLOW.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD CANNULA INTERLINK THREADED LOCK, THE DEVICE EXPERIENCED FLOW ISSUES. THIS EVENT OCCURRED 2 TIMES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: THIS IS A REPORT ABOUT A FLOW ISSUE. ACCORDING TO THE CUSTOMER'S VERBATIM REPORT, THE HCP CONNECTED A THREADED LOCK CANNULA TO THE INJECTION SITE OF A2N3374-ZBA BUT THE FLUID DIDN'T FLOW. THE HCP THEN USED ANOTHER THREADED LOCK CANNULA BUT THE FLUID STILL DIDN¿T FLOW.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1736372 BD CANNULA INTERLINK THREADED LOCK HYPODERMIC SINGLE LUMEN NEEDLE FMI BECTON DICKINSON MEDICAL SYSTEMS 1082816 00382903033690

Patients

Seq Age Sex Outcome Treatment
1 Unknown