FDA Adverse Event Malfunction Summary report: N

BD VACUTAINER® SAFETY-LOK¿ BLOOD COLLECTION SET

MDR report key: 18012496 · Received October 26, 2023

Report

Report Number
2243072-2023-01936
Event Type
Malfunction
Date Received
October 26, 2023
Date of Event
October 18, 2023
Report Date
July 24, 2024
Manufacturer
BECTON DICKINSON
Product Code
JKA
UDI-DI
00382903672813
PMA / PMN Number
K991088
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
PA, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

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 CATALOG #: 367296. D4. MEDICAL DEVICE LOT#: 2K1381. D4. MEDICAL DEVICE EXPIRATION DATE: 31-OCT-2025. D4: UDI #: (B)(4). G.5. PMA / 510(K)#: K980414. H4. DEVICE MANUFACTURE DATE: 31-DEC-2022.

Additional Manufacturer Narrative · 0

UNKNOWN MANUFACTURER: A CATALOG AND LOT NUMBER COULD NOT BE CONFIRMED FOR THIS INCIDENT AND WITHOUT THIS INFORMATION WE ARE UNABLE TO DETERMINE WHERE THE DEVICE WAS MANUFACTURED. THEREFORE, BD CORPORATE HEADQUARTERS IN FRANKLIN LAKES, NJ HAS BEEN LISTED IN SECTIONS D.3. AND G.1. AND THE FRANKLIN LAKES FDA REGISTRATION NUMBER HAS BEEN USED FOR THE MANUFACTURE REPORT NUMBER. D4. MEDICAL DEVICE LOT#: UNKNOWN. D4. MEDICAL DEVICE EXPIRATION DATE: UNKNOWN. H.3. A DEVICE EVALUATION AND/OR DEVICE HISTORY REVIEW IS ANTICIPATED BUT IS NOT COMPLETE. UPON COMPLETION, A SUPPLEMENTAL REPORT WILL BE FILED. H4. DEVICE MANUFACTURE DATE: UNKNOWN.

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 CATALOG #: 367281. D4. MEDICAL DEVICE LOT#: 23E1511. D4. MEDICAL DEVICE EXPIRATION DATE: 31-MAY-2026. D4: UDI #: (B)(4). G.5. PMA / 510(K)#: K991088. H4. DEVICE MANUFACTURE DATE: 26-AUG-2023.

Additional Manufacturer Narrative · 0

INVESTIGATION SUMMARY: BD HAD NOT RECEIVED SAMPLES, BUT 6 PHOTOS WERE PROVIDED FOR INVESTIGATION. THE PHOTOS WERE REVIEWED AND TWO DEVICE SKU'S ARE SEEN, THE MENTIONED CORRECT PRODUCT (367281; LOT 23E1511) AND THE MENTIONED INCORRECT PRODUCT (367296; 2K1381). LOT 23E1511 OF SKU 367281 WAS PACKED IN MAY 2023. LOT 2K1381 OF SKU 367296 WAS PACKED IN OCTOBER 2022. THESE TWO LOTS WERE PACKED ON DIFFERENT PACKING MACHINES AT DIFFERENT BUILDINGS. THIS MAKES IT IMPOSSIBLE FOR THE TWO SKU'S SEEN IN THE PHOTOS TO BE MIXED DURING THE MANUFACTURING PROCESS. BASED ON A REVIEW OF THE DEVICE HISTORY RECORD FOR THE INCIDENT LOT, ALL PRODUCT SPECIFICATIONS AND REQUIREMENTS FOR LOT RELEASE WERE MET. THERE WERE NO RELATED QUALITY ISSUES DURING MANUFACTURING OF THE PRODUCT. THIS COMPLAINT IS UNABLE TO BE CONFIRMED FOR THE INDICATED FAILURE MODE MIXED PRODUCT. BD WAS NOT ABLE TO IDENTIFY A ROOT CAUSE FOR THE INDICATED FAILURE MODE. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. OUR BUSINESS TEAM REGULARLY REVIEWS THE COLLECTED DATA FOR IDENTIFICATION OF EMERGING TRENDS.

Description of Event or Problem · 0

IT WAS REPORTED THAT WHILE USING BD VACUTAINER® SAFETY-LOK¿ BLOOD COLLECTION SET, THERE A MIX OF PRODUCT TYPES IN ONE BOX. NO PATIENT IMPACT REPORTED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "CUSTOMER REPORTS AS RECEIVED 367281 MIXED WITH 367926 IN SAME BOX."

Description of Event or Problem · 0

IT WAS REPORTED THAT WHILE USING BD VACUTAINER® SAFETY-LOK¿ BLOOD COLLECTION SET, THERE A MIX OF PRODUCT TYPES IN ONE BOX. NO PATIENT IMPACT REPORTED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "CUSTOMER REPORTS AS RECEIVED 367281 MIXED WITH 367926 IN SAME BOX."

Description of Event or Problem · 0

IT WAS REPORTED THAT WHILE USING BD VACUTAINER® SAFETY-LOK¿ BLOOD COLLECTION SET, THERE A MIX OF PRODUCT TYPES IN ONE BOX. NO PATIENT IMPACT REPORTED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "CUSTOMER REPORTS AS RECEIVED 367281 MIXED WITH 367926 IN SAME BOX."

Description of Event or Problem · 0

IT WAS REPORTED THAT WHILE USING BD VACUTAINER® SAFETY-LOK¿ BLOOD COLLECTION SET, THERE A MIX OF PRODUCT TYPES IN ONE BOX. NO PATIENT IMPACT REPORTED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: "CUSTOMER REPORTS AS RECEIVED 367281 MIXED WITH 367926 IN SAME BOX."

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1567226 BD VACUTAINER® SAFETY-LOK¿ BLOOD COLLECTION SET BLOOD SPECIMEN COLLECTION DEVICE JKA BECTON DICKINSON 23E1511 00382903672813

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown