FDA Adverse Event Malfunction Summary report: N

BD INSYTE¿ AUTOGUARD¿ BC SHIELDED IV CATHETER

MDR report key: 15964188 · Received December 12, 2022

Report

Report Number
1710034-2022-00794
Event Type
Malfunction
Date Received
December 12, 2022
Date of Event
November 18, 2022
Report Date
January 24, 2023
Manufacturer
BECTON DICKINSON INFUSION THERAPY SYSTEMS INC.
Product Code
FOZ
PMA / PMN Number
K201075
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OH, 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

H6: INVESTIGATION SUMMARY SINCE NO SAMPLES DISPLAYING THE CONDITION REPORTED WERE AVAILABLE FOR EXAMINATION, WE WERE UNABLE TO FULLY INVESTIGATE THIS INCIDENT. A DEVICE HISTORY RECORD REVIEW SHOWED NO NON-CONFORMANCES ASSOCIATED WITH THIS ISSUE DURING THE PRODUCTION OF THIS BATCH.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD INSYTE¿ AUTOGUARD¿ BC SHIELDED IV CATHETER WAS RETRACTING CAUSING DELAY IN THE SPRING MECHANISM. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: INSYTE AUTOGUARD BC ANGIOCATH NEEDLE RETRACTING. IT WAS DESCRIBED AS A DELAY IN THE SPRING MECHANISM. 20 GA 382533, LOT# 2192132.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE BD INSYTE¿ AUTOGUARD¿ BC SHIELDED IV CATHETER WAS RETRACTING CAUSING DELAY IN THE SPRING MECHANISM. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: INSYTE AUTOGUARD BC ANGIOCATH NEEDLE RETRACTING. IT WAS DESCRIBED AS A DELAY IN THE SPRING MECHANISM. 20 GA 382533 LOT# 2192132.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2180955 BD INSYTE¿ AUTOGUARD¿ BC SHIELDED IV CATHETER INTRAVENOUS CATHETER FOZ BECTON DICKINSON INFUSION THERAPY SYSTEMS INC. 2192132

Patients

Seq Age Sex Outcome Treatment
1 Unknown