FDA Adverse Event Malfunction Summary report: N

BD VACUTAINER® CPT¿ CELL PREPARATION TUBE WITH SODIUM HEPARIN

MDR report key: 13502213 · Received February 9, 2022

Report

Report Number
1917413-2022-00068
Event Type
Malfunction
Date Received
February 9, 2022
Date of Event
January 27, 2022
Report Date
May 16, 2022
Manufacturer
BECTON, DICKINSON & CO. (BROKEN BOW)
Product Code
JKA
UDI-DI
50382903627535
PMA / PMN Number
K891407
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
NY, 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

H.10 AN ADDITIONAL LOT # WAS REPORTED. THE INFORMATION FOR THIS LOT NUMBER IS AS FOLLOWS: D.4. MEDICAL DEVICE LOT #: 1202253 D.4. MEDICAL DEVICE EXPIRATION DATE: 2022-07-31 H.4. DEVICE MANUFACTURE DATE: 2021-07-21

Additional Manufacturer Narrative · 0

H.6. INVESTIGATION: BD HAD NOT RECEIVED SAMPLES OR PHOTOS FOR EVALUATION. THEREFORE, RETENTION SAMPLES OF THE INCIDENT LOTS WERE SELECTED FROM BD INVENTORY FOR EVALUATION AND UPON COMPLETION, NO ISSUES RELATING TO POOR BARRIER SEPARATION WERE OBSERVED. VISUAL INSPECTION SHOWED NO DEFECTS OBSERVED. ADDITIONALLY, CLINICAL TESTING WAS PERFORMED: NO DIFFICULTIES WERE ENCOUNTERED DURING BLOOD COLLECTION AND ALL TUBES APPEARED TO EXHIBIT PROPER FILL. BD WAS UNABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE (POOR BARRIER) BECAUSE THE DEFECT WAS NOT EVIDENT IN THE TESTING OF THE COMPLAINT LOT SAMPLES. REPLICATES OF BOTH RETAIN AND CONTROL SAMPLES TESTED DEMONSTRATED CLINICALLY ACCEPTABLE PERFORMANCE FOR ALL VISUAL OBSERVATIONS EVALUATED. ALL TUBES PERFORMED AS EXPECTED. BASED ON A REVIEW OF THE DEVICE HISTORY RECORD FOR THE INCIDENT LOT, ALL PRODUCT SPECIFICATIONS AND REQUIREMENTS FOR LOT RELEASE WERE MET. THERE WERE NO RELATED QUALITY ISSUES DURING MANUFACTURING OF THE PRODUCT. THIS COMPLAINT IS NOT CONFIRMED WITH RESPECT TO POOR BARRIER SEPARATION. BD WAS NOT ABLE TO IDENTIFY A ROOT CAUSE FOR THE INDICATED FAILURE MODE.

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.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD VACUTAINER® CPT¿ CELL PREPARATION TUBE WITH SODIUM HEPARIN, THE DEVICE EXPERIENCED POOR SEPARATOR MOVEMENT. THIS EVENT OCCURRED 3 TIMES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: THEY FOLLOWED ALL STANDARD PROCEDURES BUT AFTER SPINNING FOR 30 MINUTES, THE RED BLOOD CELLS DID NOT GO BELOW THE GEL LAYER. THIS HAPPENED WITH A TOTAL OF 3 TUBES ON (B)(6) 2022.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD VACUTAINER® CPT¿ CELL PREPARATION TUBE WITH SODIUM HEPARIN, THE DEVICE EXPERIENCED POOR SEPARATOR MOVEMENT. THIS EVENT OCCURRED 3 TIMES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: THEY FOLLOWED ALL STANDARD PROCEDURES BUT AFTER SPINNING FOR 30 MINUTES, THE RED BLOOD CELLS DID NOT GO BELOW THE GEL LAYER.THIS HAPPENED WITH A TOTAL OF 3 TUBES ON (B)(6) , 2022.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD VACUTAINER® CPT¿ CELL PREPARATION TUBE WITH SODIUM HEPARIN, THE DEVICE EXPERIENCED POOR SEPARATOR MOVEMENT. THIS EVENT OCCURRED 3 TIMES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: THEY FOLLOWED ALL STANDARD PROCEDURES BUT AFTER SPINNING FOR 30 MINUTES, THE RED BLOOD CELLS DID NOT GO BELOW THE GEL LAYER. THIS HAPPENED WITH A TOTAL OF 3 TUBES ON (B)(6) 2022.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD VACUTAINER® CPT¿ CELL PREPARATION TUBE WITH SODIUM HEPARIN, THE DEVICE EXPERIENCED POOR SEPARATOR MOVEMENT. THIS EVENT OCCURRED 3 TIMES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: THEY FOLLOWED ALL STANDARD PROCEDURES BUT AFTER SPINNING FOR 30 MINUTES, THE RED BLOOD CELLS DID NOT GO BELOW THE GEL LAYER. THIS HAPPENED WITH A TOTAL OF 3 TUBES ON (B)(6) 2022.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1849490 BD VACUTAINER® CPT¿ CELL PREPARATION TUBE WITH SODIUM HEPARIN BLOOD SPECIMEN COLLECTION DEVICE JKA BECTON, DICKINSON & CO. (BROKEN BOW) 362753 SEE H.10 50382903627535

Patients

Seq Age Sex Outcome Treatment
1 Unknown