FDA Adverse Event Malfunction Summary report: N

BD ULTRA-FINE¿ INSULIN SYRINGE

MDR report key: 15643093 · Received October 20, 2022

Report

Report Number
1920898-2022-00723
Event Type
Malfunction
Date Received
October 20, 2022
Date of Event
September 23, 2022
Report Date
January 5, 2023
Manufacturer
BD MEDICAL - DIABETES CARE
Product Code
FMF
PMA / PMN Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
BR
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. A DEVICE EVALUATION IS ANTICIPATED BUT HAS NOT YET BEGUN. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE FILED. INITIAL REPORTER PHONE #: (B)(6).

Additional Manufacturer Narrative · 0

THE FOLLOWING FIELDS WERE UPDATED DUE TO ADDITIONAL INFORMATION: D10: DEVICE AVAILABLE FOR EVAL YES, D10: RETURNED TO MANUFACTURER ON: H6: INVESTIGATION SUMMARY CUSTOMER RETURNED A SINGLE 0.5ML, 31 GAUGE, 6MM SYRINGE FROM LOT 0083432. THIS SYRINGE HAS HAD ITS THUMBPRESS BROKEN FROM THE PROXIMAL TIP OF THE PLUNGER ROD. ADDITIONALLY, THE PLUNGER CAP¿S BASE IS COMPRESSED TO THE POINT THAT IT HAS SPLIT IN CERTAIN SPOTS. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH# 0083432. ALL INSPECTIONS AND CHALLENGES WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATIONS. BASED ON THE SAMPLES RECEIVED, EMBECTA WAS ABLE TO CONFIRM THE CUSTOMER¿S INDICATED FAILURE OF PLUNGER CAP DAMAGE. A DEFINITIVE ROOT CAUSE CANNOT BE DETERMINED. H3 OTHER TEXT : SEE H10

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# 0083432. ALL INSPECTIONS AND CHALLENGES WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATION. H3 OTHER TEXT : SEE H10.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD ULTRA-FINE¿ INSULIN SYRINGE PROTECTIVE CAP WAS DENTED, WHICH IS A LOSS OF STERILITY. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM SPANISH TO ENGLISH: THE PROTECTIVE COVER OF THE PLUNGER WAS DENTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD ULTRA-FINE¿ INSULIN SYRINGE PROTECTIVE CAP WAS DENTED, WHICH IS A LOSS OF STERILITY. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM SPANISH TO ENGLISH: THE PROTECTIVE COVER OF THE PLUNGER WAS DENTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD ULTRA-FINE¿ INSULIN SYRINGE PROTECTIVE CAP WAS DENTED, WHICH IS A LOSS OF STERILITY. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM SPANISH TO ENGLISH: THE PROTECTIVE COVER OF THE PLUNGER WAS DENTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
377751 BD ULTRA-FINE¿ INSULIN SYRINGE PISTON SYRINGE FMF BD MEDICAL - DIABETES CARE 0083432

Patients

Seq Age Sex Outcome Treatment
1 Unknown