FDA Adverse Event Malfunction Summary report: N

BD VACUTAINER® PUSH BUTTON BLOOD COLLECTION SET

MDR report key: 14938285 · Received July 6, 2022

Report

Report Number
1710034-2022-00340
Event Type
Malfunction
Date Received
July 6, 2022
Date of Event
June 3, 2022
Report Date
October 31, 2022
Manufacturer
BECTON DICKINSON INFUSION THERAPY SYSTEMS INC.
Product Code
JKA
UDI-DI
50382903673389
PMA / PMN Number
K030573
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
SP
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 #: 2024957, MEDICAL DEVICE EXPIRATION DATE: 2024-01-31, DEVICE MANUFACTURE DATE: 2022-01-24. MEDICAL DEVICE LOT #: 2080380, MEDICAL DEVICE EXPIRATION DATE: 2024-03-31, DEVICE MANUFACTURE DATE: 2022-03-21. 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: D9: DEVICE AVAILABLE FOR EVAL: YES. D9: RETURNED TO MANUFACTURER ON: 2022-10-24. H.6. INVESTIGATION SUMMARY: BD RECEIVED 100 SAMPLES (LOT 2024957) AND 100 SAMPLES (LOT 2080380) FROM THE CUSTOMER IN SUPPORT OF THIS COMPLAINT. AN EVALUATION OF 100 RETURNED SAMPLES (LOT 2024957) DID NOT INDICATE DAMAGED TUBING, EVALUATION OF 100 RETURNED SAMPLES (LOT 2080380) INDICATED 15 DAMAGED TUBING. 5 PUSH BUTTON WINGED SETS FROM EACH BATCH NUMBER: 2024957, AND 2080380 WERE TAKEN AT RANDOM AND USED TO DRAW A TUBE WITH WATER AND NO DEFECTS WERE FOUND. BD WAS ABLE TO CONFIRM THE CUSTOMER¿S INDICATED FAILURE MODE BASED ON THE RETURNED SAMPLES. BD WAS ABLE TO DETERMINE THAT THE ROOT CAUSE FOR LOT 2024957 WAS ATTRIBUTED TO THE FAULTY COMPONENTS WITHIN THE MANUFACTURING PROCESS. BD WAS NOT ABLE TO IDENTIFY A ROOT CAUSE FOR THE INDICATED FAILURE MODE FOR LOT 2080380. THE DEVICE HISTORY RECORDS WERE REVIEWED WITH NO ISSUES BEING IDENTIFIED FOR BATCH: 2080380. ALL PROCESSES AND FINAL INSPECTIONS COMPLY WITH SPECIFICATION REQUIREMENTS. A QUALITY NOTIFICATION WAS GENERATED FOR LOT NUMBER 2024957, AND ALL AFFECTED PRODUCT WAS DISPOSITIONED: ALL PRODUCT HAS BEEN 100% VISUALLY INSPECTED FOR DAMAGED TUBING.

Additional Manufacturer Narrative · 0

H6: INVESTIGATION SUMMARY; BD DID NOT RECEIVE SAMPLES OR PHOTOGRAPHS FROM THE CUSTOMER IN SUPPORT OF THIS COMPLAINT. THEREFORE, 5 PUSH BUTTON WINGED SETS (FROM EACH BATCH NUMBER: 2024957, 2080380) FROM THE BD INVENTORY WERE TAKEN AT RANDOM AND FUNCTIONALLY TESTED AND THE ISSUES OF SEVERED TUBING OR DAMAGED PRODUCT WAS NOT FOUND. BD WAS ABLE TO CONFIRM THE CUSTOMER¿S INDICATED FAILURE MODE BASED ON THE DHR REVIEW ONLY FOR THE BATCH: 2024957, HOWEVER RETAINED SAMPLES TEST RESULTS FOR BOTH BATCHES: 2024957, 2080380 WERE SATISFACTORY. THE PROCESS WAS OBSERVED AND ROOT CAUSE WAS IDENTIFIED AND ATTRIBUTED TO THE MANUFACTURING PROCESS FOR THE LOT 2024957. BD WAS NOT ABLE TO IDENTIFY A ROOT CAUSE FOR THE INDICATED FAILURE MODE FOR THE LOT 2080380. THE DEVICE HISTORY RECORDS WERE REVIEWED WITH NO ISSUES BEING IDENTIFIED FOR THE BATCH: 2080380. ALL PROCESS AND FINAL INSPECTIONS COMPLY WITH SPECIFICATION REQUIREMENTS. QUALITY NOTIFICATION 200996642 WAS GENERATED FOR THE LOT NUMBER 2024957; ALL PRODUCT WAS DISPOSITIONED: ALL PRODUCT HAS BEEN 100% VISUALLY INSPECTED FOR DAMAGED TUBING AND ALL DEFECTED PRODUCT HAD BEEN SCRAPPED.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD VACUTAINER® PUSH BUTTON BLOOD COLLECTION SET THERE WAS FAILURE OF PRODUCT TO CONTAIN BLOOD/MEDICATION. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: "DURING USE THE KNOB WAS DAMAGED, AIR ENTERED AND THE TUBES DO NOT FILL." DURING USE.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD VACUTAINER® PUSH BUTTON BLOOD COLLECTION SET THERE WAS FAILURE OF PRODUCT TO CONTAIN BLOOD/MEDICATION. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: "DURING USE THE KNOB WAS DAMAGED, AIR ENTERED AND THE TUBES DO NOT FILL." DURING USE.

Description of Event or Problem · 0

IT WAS REPORTED WHEN USING THE BD VACUTAINER® PUSH BUTTON BLOOD COLLECTION SET THERE WAS FAILURE OF PRODUCT TO CONTAIN BLOOD/MEDICATION. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER. THE CUSTOMER STATED: "DURING USE THE KNOB WAS DAMAGED, AIR ENTERED AND THE TUBES DO NOT FILL." DURING USE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1257362 BD VACUTAINER® PUSH BUTTON BLOOD COLLECTION SET BLOOD SPECIMEN COLLECTION DEVICE JKA BECTON DICKINSON INFUSION THERAPY SYSTEMS INC. 367338 SEE H.10 50382903673389

Patients

Seq Age Sex Outcome Treatment
1 Unknown