BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PEN NDL 32G 4MM 90 CT MAIL ORDER ONLY

    MDR report key: 18993852 · Received March 28, 2024

    Report

    Report Number
    9616656-2024-05191
    Event Type
    Malfunction
    Date Received
    March 28, 2024
    Report Date
    June 20, 2024
    Manufacturer
    BECTON DICKNSON AND CO. - DUN LAOGHAIRE CO, IRELAND
    Product Code
    FMI
    PMA / PMN Number
    K213478
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    ADDITIONAL INFORMATION WAS ADDED TO: B4, G6, H2, H3, H11. CORRECTION TO: D3 (COUNTRY TYPE AND COUNTRY), H6 (TYPE OF INVESTIGATION AND INVESTIGATION CONCLUSIONS). INVESTIGATION SUMMARY: NO SAMPLES (INCLUDING PHOTOS) WERE RETURNED THEREFORE THE COMPLAINT COULD NOT BE CONFIRMED AND THE ROOT CAUSE IS UNDETERMINED. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. IF SAMPLES ARE RECEIVED IN THE FUTURE THE COMPLAINT WILL BE REOPENED FOR FURTHER INVESTIGATION. BASED ON THE ABOVE, NO ADDITIONAL INVESTIGATION AND NO CAPA/SA IS REQUIRED AT THIS TIME.

    Description of Event or Problem · 0

    CONSUMER REPORTED FINDING THE NEEDLES HARD TO PLACE ON PENS. CONSUMER REPORTED FINDING THE NEEDLES TO INJECT PART THE WAY FOR THE DOSE AND THEN CLOGS. DC. LOT # 3172422 UNKNOWN AMOUNTS. LOT # UNKNOWN = TOTAL ALL OF THE SAMPLES. CATALOG# 320883. DATE OF EVENT UNKNOWN. SAMPLE STATUS AWAITING SAMPLE: CS0070143.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1220960 PEN NDL 32G 4MM 90 CT MAIL ORDER ONLY NEEDLE, HYPODERMIC, SINGLE LUMEN FMI BECTON DICKNSON AND CO. - DUN LAOGHAIRE CO, IRELAND 320883 UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown