FDA Adverse Event Malfunction Summary report: N

SYRINGE 10ML SALINE FILL CHINA SP

MDR report key: 18710924 · Received February 15, 2024

Report

Report Number
1911916-2024-00099
Event Type
Malfunction
Date Received
February 15, 2024
Date of Event
February 6, 2024
Report Date
March 18, 2024
Manufacturer
BECTON DICKINSON
Product Code
NGT
UDI-DI
30382903065951
PMA / PMN Number
K003553
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 306595 AND LOT NUMBER 3233687. 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, A DEVICE EVALUATION, OR A DEVICE HISTORY REVIEW IS COMPLETED. H3 OTHER TEXT : SEE H10 MANUFACTURE NARRATIVE

Description of Event or Problem · 0

NO ADDITIONAL INFORMATION RECEIVED. THE NURSE IN THE NEUROSURGERY WARD WAS PREPARING TO SEAL THE PATIENT'S TUBE, TOOK OUT THE PREFILLED CATHETER IRRIGATOR, AND FOUND THAT THERE WAS LEAKAGE IN THE TUBE WALL. AFTER INSPECTION, IT WAS FOUND THAT THERE WAS A CRACK IN THE TUBE WALL CAUSING LEAKAGE, SO SHE IMMEDIATELY DISCARDED IT AND REPLACED THE PREFILLED CATHETER IRRIGATOR TO COMPLETE THE OPERATION.

Description of Event or Problem · 0

THE NURSE IN THE NEUROSURGERY WARD WAS PREPARING TO SEAL THE PATIENT'S TUBE, TOOK OUT THE PREFILLED CATHETER IRRIGATOR, AND FOUND THAT THERE WAS LEAKAGE IN THE TUBE WALL. AFTER INSPECTION, IT WAS FOUND THAT THERE WAS A CRACK IN THE TUBE WALL CAUSING LEAKAGE, SO SHE IMMEDIATELY DISCARDED IT AND REPLACED THE PREFILLED CATHETER IRRIGATOR TO COMPLETE THE OPERATION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2086683 SYRINGE 10ML SALINE FILL CHINA SP SALINE, VASCULAR ACCESS FLUSH NGT BECTON DICKINSON 3233687 30382903065951

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown