FDA Adverse Event Malfunction Summary report: N

BD GLIDE¿ WITH TBL BD ULTRA-FINE¿ NEEDLE INSULIN SYRINGE

MDR report key: 15670818 · Received October 25, 2022

Report

Report Number
1920898-2022-00740
Event Type
Malfunction
Date Received
October 25, 2022
Date of Event
September 29, 2022
Report Date
January 5, 2023
Manufacturer
BD MEDICAL - DIABETES CARE
Product Code
FMF
UDI-DI
10382903249029
PMA / PMN Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IN
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

H6: INVESTIGATION SUMMARY NO SAMPLES WERE RETURNED THEREFORE THE INVESTIGATION WAS PERFORMED BASED ON THE PHOTO PROVIDED. CUSTOMER RETURNED AN IMAGE OF 31GX6MM SYRINGE FROM LOT 1200820. THE CUSTOMER REPORTED THAT ONE SYRINGE WAS FOUND TO BE CONTAMINATED. THE IMAGES WERE EXAMINED AND THERE IS A TRANSLUCENT BEAD OF LIQUID THAT HAS SOLIDIFIED AT THE TIP. THIS MATERIAL MAY BE THE ADHESIVE MEANT TO HOLD THE NEEDLE IN PLACE. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH # 1200820. ALL INSPECTIONS AND CHALLENGES WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATIONS. BASED ON THE IMAGES RECEIVED, EMBECTA WAS ABLE TO CONFIRM THE CUSTOMER¿S INDICATED FAILURE OF FOREIGN MATTER ON NEEDLE. NO DEFINITIVE ROOT CAUSE CAN BE DETERMINED.

Additional Manufacturer Narrative · 0

DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. INITIAL REPORTER E-MAIL: UNKNOWN. 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 THAT FOREIGN MATTER WAS FOUND ON THE NEEDLE OF THE BD GLIDE¿ WITH TBL BD ULTRA-FINE¿ NEEDLE INSULIN SYRINGE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "CUSTOMER IS REGULAR USER OF BD GLIDE U 40 INSULIN SYRINGE , FOUND ONE SYRINGE WITH CONTAMINATED NEEDLE, THIS IS SECOND TIME THEY HAVE FOUND IT."

Description of Event or Problem · 0

IT WAS REPORTED THAT FOREIGN MATTER WAS FOUND ON THE NEEDLE OF THE BD GLIDE¿ WITH TBL BD ULTRA-FINE¿ NEEDLE INSULIN SYRINGE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "CUSTOMER IS REGULAR USER OF BD GLIDE U 40 INSULIN SYRINGE , FOUND ONE SYRINGE WITH CONTAMINATED NEEDLE, THIS IS SECOND TIME THEY HAVE FOUND IT."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2775985 BD GLIDE¿ WITH TBL BD ULTRA-FINE¿ NEEDLE INSULIN SYRINGE PISTON SYRINGE FMF BD MEDICAL - DIABETES CARE 1200820 10382903249029

Patients

Seq Age Sex Outcome Treatment
1 Unknown