FDA Adverse Event Malfunction Summary report: N

BD ULTRA-FINE¿ INSULIN SYRINGE WITH STERILE INTERIOR

MDR report key: 17312953 · Received July 12, 2023

Report

Report Number
1920898-2023-00437
Event Type
Malfunction
Date Received
July 12, 2023
Date of Event
June 18, 2023
Report Date
November 2, 2023
Manufacturer
BD MEDICAL - DIABETES CARE
Product Code
FMI
PMA / PMN Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
KS
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE FOLLOWING FIELDS WERE UPDATED DUE TO ADDITIONAL INFORMATION: D10: DEVICE AVAILABLE FOR EVAL YES, D10: RETURNED TO MANUFACTURER ON: 14-JUL-2023. H6: INVESTIGATION SUMMARY CUSTOMER RETURNED A FULL SHELF CARTON WITH 31GA 6MM SYRINGES.TWO OF THE POLYBAGS WERE RETURNED OPEN. CUSTOMER STATED THAT "A THIN BLACK LINE AND BLACK DOTS ARE ON THE NEEDLE SURFACE. THE SYRINGES FROM THE OPEN BAGS WERE VISUALLY INSPECTED UNDER THE MICROSCOPE AND SMALL BLACK MARKS WERE OBSERVED ON THE CANNULA SURFACES THAT LOOKED LIKE DISCOLORATION OF THE CANNULA METAL. THE CANNULA WAS SCRAPED USING THE SAFETY KNIFE, AND WE WERE NOT ABLE TO GET ANY FOREIGN MATERIAL FROM THE BLACK LINES ON THE CANNULA SURFACE FOR FTIR TESTING. A DEVICE HISTORY RECORD REVIEW SHOWED NO NON-CONFORMANCES ASSOCIATED WITH THIS ISSUE DURING THE PRODUCTION OF THIS BATCH. EMBECTA WAS ABLE TO CONFIRM THE CUSTOMER-INDICATED FAILURE BLACK MARKS ON THE CANNULA SURFACE.

Additional Manufacturer Narrative · 0

CORRECTION: H.6. INVESTIGATION SUMMARY: SAMPLES WERE RECEIVED AND AN INVESTIGATION WAS PERFORMED. THIS IS THE 2ND COMPLAINT FOR LOT 2213126 AND THE 4TH COMPLAINT FOR THE REPORTED LOT NUMBER 2199495. A REVIEW OF THE MANUFACTURING RECORDS WAS PERFORMED AND NO NON-CONFORMANCES WERE RAISED IN ASSOCIATION WITH THIS TYPE OF EVENT FOR THIS LOT. EMBECTA WAS NOT ABLE TO DUPLICATE OR CONFIRM THE INDICATED ISSUE AND BASED ON TREND ANALYSIS NO FURTHER ACTION IS REQUIRED AT THIS TIME. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. BASED ON THE ABOVE, NO ADDITIONAL INVESTIGATION AND CORRECTIVE/PREVENTATIVE ACTION (CAPA) OR SITUATIONAL ANALYSIS (SA) IS REQUIRED.

Additional Manufacturer Narrative · 0

THERE WERE MULTIPLE LOT NUMBERS REPORTED TO BE INVOLVED. THE INFORMATION FOR EACH ADDITIONAL LOT NUMBER IS AS FOLLOWS: D4. MEDICAL DEVICE LOT #: 2213126 D4. MEDICAL DEVICE EXPIRATION DATE: 31AUG2027 H4. DEVICE MANUFACTURE DATE: 01AUG2022 H.3. A DEVICE EVALUATION AND/OR DEVICE HISTORY REVIEW IS ANTICIPATED BUT IS NOT COMPLETE. UPON COMPLETION, A SUPPLEMENTAL REPORT WILL BE FILED.

Description of Event or Problem · 0

IT WAS REPORTED WHILE USING BD ULTRA-FINE¿ INSULIN SYRINGE WITH STERILE INTERIOR FOREIGN MATTER WAS FOUND. THERE WAS NO REPORT OF PATIENT IMPACT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: FM ISSUE - BLACK LINE AND DOT ON THE NEEDLE SURFACE CUSTOMER STATED THAT "A THIN BLACK LINE AND BLACK DOTS ARE ON THE NEEDLE SURFACE."

Description of Event or Problem · 0

IT WAS REPORTED WHILE USING BD ULTRA-FINE¿ INSULIN SYRINGE WITH STERILE INTERIOR FOREIGN MATTER WAS FOUND. THERE WAS NO REPORT OF PATIENT IMPACT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: FM ISSUE - BLACK LINE AND DOT ON THE NEEDLE SURFACE CUSTOMER STATED THAT "A THIN BLACK LINE AND BLACK DOTS ARE ON THE NEEDLE SURFACE."

Description of Event or Problem · 0

IT WAS REPORTED WHILE USING BD ULTRA-FINE¿ INSULIN SYRINGE WITH STERILE INTERIOR FOREIGN MATTER WAS FOUND. THERE WAS NO REPORT OF PATIENT IMPACT. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: FM ISSUE - BLACK LINE AND DOT ON THE NEEDLE SURFACE CUSTOMER STATED THAT "A THIN BLACK LINE AND BLACK DOTS ARE ON THE NEEDLE SURFACE."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2170247 BD ULTRA-FINE¿ INSULIN SYRINGE WITH STERILE INTERIOR HYPODERMIC SINGLE LUMEN NEEDLE FMI BD MEDICAL - DIABETES CARE 2199495

Patients

Seq Age Sex Outcome Treatment
1 Unknown