FDA Adverse Event Malfunction Summary report: N

BD LUER-LOK¿ SYRINGE

MDR report key: 13459298 · Received February 4, 2022

Report

Report Number
8041187-2022-00067
Event Type
Malfunction
Date Received
February 4, 2022
Date of Event
January 21, 2022
Report Date
February 23, 2022
Manufacturer
BECTON DICKINSON MEDICAL (SINGAPORE)
Product Code
FMF
PMA / PMN Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
AS
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THERE WERE MULTIPLE LOT NUMBERS REPORTED TO BE INVOLVED. THE INFORMATION FOR EACH LOT NUMBER IS AS FOLLOWS: MEDICAL DEVICE LOT #: 1140582. MEDICAL DEVICE EXPIRATION DATE: 2026-05-31. DEVICE MANUFACTURE DATE: 2021-06-17. MEDICAL DEVICE LOT #: 1104061. MEDICAL DEVICE EXPIRATION DATE: 2026-04-30. DEVICE MANUFACTURE DATE: 2021-05-14. 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 LOT NUMBERS REPORTED TO BE INVOLVED. THE INFORMATION FOR EACH LOT NUMBER IS AS FOLLOWS: MEDICAL DEVICE LOT #: 1140582. MEDICAL DEVICE EXPIRATION DATE: 2026-05-31. DEVICE MANUFACTURE DATE: 2021-06-17. MEDICAL DEVICE LOT #: 1104061. MEDICAL DEVICE EXPIRATION DATE: 2026-04-30. DEVICE MANUFACTURE DATE: 2021-05-14. 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: D.9. DEVICE AVAILABLE FOR EVAL?: YES. D.9. RETURNED TO MANUFACTURER ON: 2/11/2022. H.6. INVESTIGATION: ONE PHOTO AND ONE SAMPLE WERE RECEIVED BY OUR QUALITY TEAM FOR EVALUATION. FROM THE PHOTO AND SAMPLE, STOPPER POOR ASSEMBLY WAS OBSERVED. 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 PROBABLE ROOT CAUSE COULD BE THAT THE STOPPER WAS NOT PROPERLY SEATED ON THE LOWER TOOLING RESULTING IN THE NON-CONFORMANCE. THERE IS A VISION SYSTEM AT THE ASSEMBLY MACHINE WHICH CAN DETECT AND AUTO-REJECT SUCH NON-CONFORMANCE. THE RETURNED SAMPLE WAS CHALLENGED AT THE ASSEMBLY VISION SYSTEM AND ABLE TO BE REJECTED AT 180-DEGREE POINT OF VIEW. THEREFORE, THE NONCONFORMANCE COULD HAVE BEEN ESCAPEES RESULTING IT TO FLOW TO THE NEXT PROCESS.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE STOPPER PARTIALLY SEPARATED FROM THE BD LUER-LOK¿ SYRINGE PLUNGER, CAUSING IT TO GET STUCK AND FLUID TO LEAK PAST IT. THIS OCCURRED ONCE EACH IN LOTS 1140582 AND 1104061. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "PLUNGER GET STUCK IN THE TUBE, THIS CAUSE FLUID TO DRAIN OUT BY THE PLUNGER END OF THE SYRINGE."

Description of Event or Problem · 0

IT WAS REPORTED THAT THE STOPPER PARTIALLY SEPARATED FROM THE BD LUER-LOK¿ SYRINGE PLUNGER, CAUSING IT TO GET STUCK AND FLUID TO LEAK PAST IT. THIS OCCURRED ONCE EACH IN LOTS 1140582 AND 1104061. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "PLUNGER GET STUCK IN THE TUBE, THIS CAUSE FLUID TO DRAIN OUT BY THE PLUNGER END OF THE SYRINGE."

Description of Event or Problem · 0

IT WAS REPORTED THAT THE STOPPER PARTIALLY SEPARATED FROM THE BD LUER-LOK¿ SYRINGE PLUNGER, CAUSING IT TO GET STUCK AND FLUID TO LEAK PAST IT. THIS OCCURRED ONCE EACH IN LOTS 1140582 AND 1104061. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "PLUNGER GET STUCK IN THE TUBE, THIS CAUSE FLUID TO DRAIN OUT BY THE PLUNGER END OF THE SYRINGE."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1235284 BD LUER-LOK¿ SYRINGE PISTON SYRINGE FMF BECTON DICKINSON MEDICAL (SINGAPORE) SEE SECTION H10

Patients

Seq Age Sex Outcome Treatment
1 Unknown