FDA Adverse Event Malfunction Summary report: N

BD POSIFLUSH¿ PREFILLED NORMAL SALINE FLUSH SYRINGE

MDR report key: 17703482 · Received September 7, 2023

Report

Report Number
1911916-2023-00643
Event Type
Malfunction
Date Received
September 7, 2023
Date of Event
August 21, 2023
Report Date
December 11, 2023
Manufacturer
BD MEDICAL (BD WEST) MEDICAL SURGICAL
Product Code
FOZ
UDI-DI
30382903065463
PMA / PMN Number
K003553
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
VA, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

A DEVICE HISTORY RECORD REVIEW WAS COMPLETED FOR PROVIDED MATERIAL NUMBER 306546 AND LOT NUMBER 3103219. THE REVIEW DID NOT REVEAL ANY POSSIBLE NON-CONFORMANCES DURING THE PRODUCTION PROCESS THAT COULD HAVE CONTRIBUTED TO THIS REPORTED INCIDENT. TO AID IN THE INVESTIGATION OF THIS ISSUE, 132 PHYSICAL SAMPLES WERE RETURNED FOR EVALUATION BY OUR QUALITY ENGINEER TEAM. THE SAMPLES WERE ALL LOOSELY PACKED IN A BOX WITH THEIR ORIGINAL FLOW WRAP PACKAGING. GLIDE FORCE TESTING WAS PERFORMED ON ALL OF THE RETURNED SAMPLES. OUT OF 132 SAMPLES TESTED, 17 FAILED THE GLIDE FORCE TESTING; CONFIRMING THE REPORTED DEFECT OF PLUNGER MOVEMENT DIFFICULTY DUE TO DRY BARRELS. THE MOST PROBABLE CAUSE FOR THE DEFECTIVE PRODUCT WAS A FAULTY THERMOCOUPLE, WHICH WAS REPLACED EARLIER THIS YEAR. THE THERMOCOUPLE CONTROLS THE DISPERSION OF SILICONE IN THE SYRINGE BARREL. THE FAULTY THERMOCOUPLE IN TURN LED TO INTERMITTENT DEFECTS WHICH WERE NOT DETECTED DURING THE IN-PROCESS CHECKS. OUR QUALITY TEAM WILL CONTINUE TO CLOSELY MONITOR THE MANUFACTURING PROCESS FOR SIGNS OF THIS POTENTIAL DEFECT AND ANY EMERGING TRENDS.

Additional Manufacturer Narrative · 0

H3. 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 THE PLUNGER ON THE BD POSIFLUSH¿ PREFILLED NORMAL SALINE FLUSH SYRINGE WAS DIFFICULT TO MOVE. THE FOLLOWING WAS RECEIVED BY THE INITIAL REPORTER: CUSTOMER HAVING TROUBLE PUSHING OUT FLUIDS 10 ML PREFILLED SYRINGES.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1038349 BD POSIFLUSH¿ PREFILLED NORMAL SALINE FLUSH SYRINGE SALINE, VASCULAR ACCESS FLUSH FOZ BD MEDICAL (BD WEST) MEDICAL SURGICAL 3103219 30382903065463

Patients

Seq Age Sex Outcome Treatment
1 Unknown