FDA Adverse Event Malfunction Summary report: N

BD ULTRA-FINE¿ 3/10ML INSULIN SYRINGE

MDR report key: 15553488 · Received October 6, 2022

Report

Report Number
1920898-2022-00692
Event Type
Malfunction
Date Received
October 6, 2022
Date of Event
September 13, 2022
Report Date
December 14, 2022
Manufacturer
BD MEDICAL - DIABETES CARE
Product Code
FMF
PMA / PMN Number
NA
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

H6: INVESTIGATION SUMMARY: NO SAMPLES (INCLUDING PHOTOS) WERE RETURNED THEREFORE THE COMPLAINT COULD NOT BE CONFIRMED AND THE ROOT CAUSE IS UNDETERMINED. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH# 1200370. ALL INSPECTIONS WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATION.

Additional Manufacturer Narrative · 0

THE FOLLOWING FIELDS WERE UPDATED DUE TO ADDITIONAL INFORMATION: D10: DEVICE AVAILABLE FOR EVAL YES, D10: RETURNED TO MANUFACTURER ON: 27-OCT-2022. H6: INVESTIGATION SUMMARY: CUSTOMER RETURNED (2) 0.3ML, 29 GAUGE, 12.7MM SYRINGES FROM LOT 1200370. THE SYRINGES WERE RETURNED DISASSEMBLED, WITH THE PLUNGER ROD AND CAP REMOVED FROM THE SYRINGE. WHEN INSERTED INTO THE SYRINGE, THE PLUNGER ROD ITSELF REMAINS IN PLACE AND SLIGHTLY RESISTS MOVEMENT UP AND DOWN THE SYRINGE BARREL AS INTENDED. THERE IS NO INDICATION THAT THE PLUNGER ROD WOULD BE CAPABLE OF FALLING OUT OF THE BARREL ON ITS OWN. ADDITIONALLY, THERE ARE NO MARKINGS OR DEFECTS THAT COULD DETAIL PREVIOUS DIFFICULTY WITH THE PLUNGER ROD, AS THE STOPPER REMAINS IN PLACE AND DOES NOT FEATURE ANY DEFECTS. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH # 1200370 ALL INSPECTIONS WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATIONS. BASED ON THE SAMPLES RECEIVED, EMBECTA WAS UNABLE TO DIRECTLY CONFIRM THE CUSTOMER¿S INDICATED FAILURE OF SEPARATED PLUNGER RODS. ROOT CAUSE CANNOT BE DETERMINED AT THIS TIME AS THE ISSUE IS UNCONFIRMED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD ULTRA-FINE¿ 3/10ML INSULIN SYRINGE EXPERIENCED THE PLUNGER FALLING OUT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM JAPANESE: WHEN THE PLUNGER CAP WAS REMOVED, THE PLUNGER ROD WAS SEPARATED FROM THE BARREL. THE SEPARATED PLUNGER ROD HAS BECOME UNSANITARY AND CAN NO LONGER BE USED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD ULTRA-FINE¿ 3/10ML INSULIN SYRINGE EXPERIENCED THE PLUNGER FALLING OUT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM JAPANESE: WHEN THE PLUNGER CAP WAS REMOVED, THE PLUNGER ROD WAS SEPARATED FROM THE BARREL. THE SEPARATED PLUNGER ROD HAS BECOME UNSANITARY AND CAN NO LONGER BE USED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD ULTRA-FINE¿ 3/10ML INSULIN SYRINGE EXPERIENCED THE PLUNGER FALLING OUT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM JAPANESE: WHEN THE PLUNGER CAP WAS REMOVED, THE PLUNGER ROD WAS SEPARATED FROM THE BARREL. THE SEPARATED PLUNGER ROD HAS BECOME UNSANITARY AND CAN NO LONGER BE USED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2801167 BD ULTRA-FINE¿ 3/10ML INSULIN SYRINGE PISTON SYRINGE FMF BD MEDICAL - DIABETES CARE 1200370

Patients

Seq Age Sex Outcome Treatment
1 Unknown