FDA Adverse Event Malfunction Summary report: N

BD LUER-LOK¿ SYRINGE

MDR report key: 13480638 · Received February 8, 2022

Report

Report Number
1213809-2022-00054
Event Type
Malfunction
Date Received
February 8, 2022
Date of Event
January 20, 2022
Report Date
February 23, 2022
Manufacturer
BECTON DICKINSON MEDICAL SYSTEMS
Product Code
FMF
PMA / PMN Number
K941562
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IL, US
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

CORRECTION: THE CUSTOMER PROVIDED THE CORRECT MATERIAL AND LOT#. THE FOLLOWING FIELDS HAVE BEEN UPDATED: B.5. DESCRIBE EVENT OR PROBLEM: IT WAS REPORTED THAT THE BD LUER-LOK¿ SYRINGE HAD NO SCALE MARKINGS ON IT. D.1. MEDICAL DEVICE BRAND NAME: BD LUER-LOK¿ SYRINGE. D.2. MEDICAL DEVICE CATALOG#: 309648. D.4. MEDICAL DEVICE LOT #: 1127509. D.4. MEDICAL DEVICE EXPIRATION DATE: 2026-04-30. D.5. UNIQUE IDENTIFIER (UDI) #: (B)(4). G.5. PMA / 510(K)#: K941562. H.4. DEVICE MANUFACTURE DATE: 2021-05-07.

Additional Manufacturer Narrative · 0

H.6. INVESTIGATION: ONE PHOTO WAS RECEIVED AND EVALUATED. THE PHOTO DISPLAYED A SINGLE 1ML LUER LOCK SYRINGE (P/N 309648) WITH A PIECE OF TAPE APPLIED TO THE COLLAR. THE GRADUATED SCALE WAS COMPLETELY MISSING FROM THE SYRINGE WHICH WAS A NON-CONFORMING CONDITION PER PRODUCT SPECIFICATION. POTENTIAL ROOT CAUSE FOR THE MISSING PRINT DEFECT IS ASSOCIATED WITH THE MARKING PROCESS. 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 THAT THE BD¿ LUER SLIP TIP SYRINGE HAD NO SCALE MARKINGS ON IT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "THERE WAS NO MARKINGS OF MEASUREMENT IN ONE OF THE SYRINGE IN THE PACK."

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD¿ LUER SLIP TIP SYRINGE HAD NO SCALE MARKINGS ON IT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "THERE WAS NO MARKINGS OF MEASUREMENT IN ONE OF THE SYRINGE IN THE PACK."

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD LUER-LOK¿ SYRINGE HAD NO SCALE MARKINGS ON IT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "THERE WAS NO MARKINGS OF MEASUREMENT IN ONE OF THE SYRINGE IN THE PACK."

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD LUER-LOK¿ SYRINGE HAD NO SCALE MARKINGS ON IT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "THERE WAS NO MARKINGS OF MEASUREMENT IN ONE OF THE SYRINGE IN THE PACK."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1596004 BD LUER-LOK¿ SYRINGE PISTON SYRINGE FMF BECTON DICKINSON MEDICAL SYSTEMS 1127509

Patients

Seq Age Sex Outcome Treatment
1 Unknown