FDA Adverse Event Malfunction Summary report: N

SYRINGE 1.0ML 31GA 8MM UFII 10BAG 500CS

MDR report key: 18499490 · Received January 11, 2024

Report

Report Number
1920898-2024-05005
Event Type
Malfunction
Date Received
January 11, 2024
Report Date
April 8, 2024
Manufacturer
BD MEDICAL - DIABETES CARE - HOLDREGE, NE / 68949
Product Code
FMF
UDI-DI
00382908418034
PMA / PMN Number
K190054
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

INVESTIGATION SUMMARY: SAMPLES WERE RECEIVED AND AN INVESTIGATION WAS PERFORMED. THIS IS THE 1ST COMPLAINT FOR THE REPORTED LOT NUMBER. 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 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.

Description of Event or Problem · 0

CONSUMER REPORTED THAT THE RUBBER STOPPER IS DAMAGED, HE STATED THAT IT APPEARS TO MELTED IN THE BARREL. CONSUMER ALSO REPORTED THAT THE PLUNGER ROD IS DIFFICULT TO MOVE. CONSUMER DOES NOT RE-USE. CONSUMER ONLY SAVED THE SYRINGE WITH THE DAMAGED STOPPER, THE OTHER SYRINGES WERE DISCARDED. LOT #: 3030357. CATALOG #: 328418. DATE OF EVENT: UNKNOWN. SAMPLES: AVAILABLE - SENDING MAIL KIT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1818029 SYRINGE 1.0ML 31GA 8MM UFII 10BAG 500CS SYRINGE, PISTON FMF BD MEDICAL - DIABETES CARE - HOLDREGE, NE / 68949 328418 3030357 00382908418034

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown