CARDINALHEALTH
Report
- Report Number
- 3005670221-2024-00008
- Event Type
- Malfunction
- Date Received
- April 11, 2024
- Report Date
- April 12, 2024
- Manufacturer
- JIANGSU CAINA MEDICAL CO., LTD.
- Product Code
- FMF
- UDI-DI
- 10192253034530
- PMA / PMN Number
- K113091
- Removal / Correction Number
- Z-0851-2024
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CH
- Reporter Occupation
- OTHER HEALTH CARE PROFESSIONAL
- Health Professional
- Yes
Narratives
RETURNED SAMPLE WAS REQUESTED BUT HAVEN'T RECEIVED YET. THE DHR OF THIS LOT WAS REVIEWED WITHOUT ANY ISSUE. THE DESIGN HISTORY FILE AND 510K SUMBSSION WERE REVIEWED. THIS SYRINGE IS DESIGNED FOR MANUAL USE ONLY, NOT FOR PUMP USE. FOR MANUAL USE OR NOT FOR PUMP USE WAS NOT PRESENTED ON ANY LABELING OF THIS PRODUCT. THE COMPLIANT HISTORY WAS REVIEWED NO PUMP COMPATBILITY ISSUES WITH THIS PRODUCT WERE RECEIVED BEFORE. A RECALL WAS CONDUCTED BY DISTRIBUTOR CARDINAL HEALTH 200 LLC WITH RECALL NUMBER Z-0851-2024. THE CORRETIVE ACTION PUTTING THE CAUTION "FOR MANUAL USE OR NOT FOR PUMP USE" ON ALL SYRINGES' LABELING OF K113091 WILL BE TAKEN. A FOLLOW-UP REPORT WILL BE SUBMITTED IF ANY ADDITIONAL INFORMATION FROM THE RECEIVED SAMPLES.
THE CUSTOMER REPORTED THAT THEY RECEIVED SOME FUNNY-LOOKING TB SYRINGES WITH AN EXTENDED BLACK PLUNGER TIP THAT LOOKS LIKE THE TIP OF A SHARPIE. THE INCORRECT ITEM CAUSED SOME ISSUES IN THEIR CARDIAC AREA WITH THEM NOT BEING ABLE TO FULLY INFUSE MEDICATIONS. PHOTOS ATTACHED. ADDITIONAL INFORMATION RECEIVED ON 09AUG2023 STATED THAT THERE WAS NO INJURY TO THE PATIENT BUT DID RESULT IN A DELAY IN MEDICATION ADMINISTRATION. NO INTERVENTIONS WERE REQUIRED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 836974 | CARDINALHEALTH | SYRINGE | FMF | JIANGSU CAINA MEDICAL CO., LTD. | 230201 230204 | 10192253034530 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | NA | Unknown | Other |