BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SYRINGE 5ML SALINE FILL CHINA SP

    MDR report key: 17952742 · Received October 17, 2023

    Report

    Report Number
    1911916-2023-00780
    Event Type
    Malfunction
    Date Received
    October 17, 2023
    Date of Event
    August 12, 2023
    Report Date
    November 1, 2023
    Manufacturer
    BECTON DICKINSON
    Product Code
    NGT
    UDI-DI
    30382903065944
    PMA / PMN Number
    UNK
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CH
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    (B)(4) FOLLOW UP: A DEVICE HISTORY RECORD REVIEW WAS COMPLETED BY OUR QUALITY ENGINEER TEAM FOR PROVIDED MATERIAL NUMBER 306594 AND LOT NUMBER 2095391. THE REVIEW DID NOT REVEAL ANY DETECTED ABNORMALITIES DURING THE PRODUCTION PROCESS THAT COULD HAVE CONTRIBUTED TO THIS DEFECT AND ALL QUALITY TESTS WERE FOUND TO BE WITHIN SPECIFICATION. AS A SAMPLE WAS UNAVAILABLE FOR RETURN, A THOROUGH SAMPLE INVESTIGATION COULD NOT BE COMPLETED. BASED ON THE INVESTIGATION RESULTS, AN EXACT CAUSE FOR THIS INCIDENT COULD NOT BE IDENTIFIED. SHOULD YOU AGAIN EXPERIENCE ANY PROBLEMS WITH OUR PRODUCT WE WOULD APPRECIATE THE OPPORTUNITY TO CONDUCT A THOROUGH ANALYSIS. THERE ARE QUALITY CONTROLS CURRENTLY IN PLACE TO DETECT THIS TYPE OF DEFECT DURING THE PRODUCTION PROCESS. FURTHER ACTION HAS NOT BEEN DETERMINED NECESSARY AT THIS TIME.

    Additional Manufacturer Narrative · 0

    (B)(4): INITIAL MDR SUBMISSION. A FOLLOW UP MDR WILL BE SUBMITTED IF ADDITIONAL INFORMATION BECOMES AVAILABLE. DEVICE PROBLEM CODE - A140303 - SHORT FILL. PATIENT PROBLEM CODE: F26 ¿ NO HEALTH CONSEQUENCES OR IMPACT.

    Description of Event or Problem · 0

    NO ADDITIONAL INFORMATION RECEIVED. THE PATIENT WAS ADMITTED FOR MIXED HEMORRHOIDS AND WAS FLUSHED USING A PREFILLED CATHETER FLOSSER AT 0830 HOURS ON (B)(6) 2023 WHEN AN INSUFFICIENT AMOUNT OF FLUID WAS FOUND, WHICH DID NOT HARM THE PATIENT AND WAS REPLACED IMMEDIATELY.

    Description of Event or Problem · 0

    THE PATIENT WAS ADMITTED FOR MIXED HEMORRHOIDS AND WAS FLUSHED USING A PREFILLED CATHETER FLOSSER AT 0830 HOURS ON (B)(6) 2023 WHEN AN INSUFFICIENT AMOUNT OF FLUID WAS FOUND, WHICH DID NOT HARM THE PATIENT AND WAS REPLACED IMMEDIATELY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2054535 SYRINGE 5ML SALINE FILL CHINA SP SALINE, VASCULAR ACCESS FLUSH NGT BECTON DICKINSON 2095391 30382903065944

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown