FDA Adverse Event Malfunction Summary report: N

BD VACUTAINER® K2 EDTA (K2E) 5.4MG BLOOD COLLECTION TUBES

MDR report key: 19293281 · Received May 10, 2024

Report

Report Number
1917413-2024-00403
Event Type
Malfunction
Date Received
May 10, 2024
Date of Event
April 15, 2024
Report Date
June 18, 2024
Manufacturer
BECTON, DICKINSON & CO. (BROKEN BOW)
Product Code
GIM
UDI-DI
30382903678564
PMA / PMN Number
BK230980
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MN, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE FOLLOWING WAS UPDATED : INVESTIGATION SUMMARY MATERIAL #: 367856. LOT/BATCH #: 3163664. BD HAD NOT RECEIVED SAMPLES, BUT 2 PHOTOS WERE PROVIDED FOR INVESTIGATION. THE PHOTOS WERE REVIEWED AND THE INDICATED FAILURE MODE FOR DAMAGED TUBE INTERIOR WAS OBSERVED. ADDITIONALLY, 100 RETENTION SAMPLES FROM BD INVENTORY WERE EVALUATED BY VISUAL EXAMINATION AND NO ISSUES WERE OBSERVED RELATING TO DAMAGED TUBE INTERIOR AS ALL SAMPLES MET SPECIFICATIONS. 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 HAS BEEN CONFIRMED FOR THE INDICATED FAILURE MODE DAMAGED TUBE INTERIOR. 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.

Additional Manufacturer Narrative · 0

H.6 INVESTIGATION SUMMARY. BD HAD NOT RECEIVED SAMPLES, BUT 2 PHOTOS WERE PROVIDED FOR INVESTIGATION. THE PHOTOS WERE REVIEWED AND THE INDICATED FAILURE MODE FOR DAMAGED TUBE INTERIOR WITH THE INCIDENT LOT WAS NOT OBSERVED. ADDITIONALLY, 100 RETENTION SAMPLES FROM BD INVENTORY WERE EVALUATED BY VISUAL EXAMINATION AND NO ISSUES WERE OBSERVED RELATING TO DAMAGED TUBE INTERIOR AS ALL SAMPLES MET SPECIFICATIONS. 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 DAMAGED TUBE INTERIOR. 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.

Additional Manufacturer Narrative · 0

D.2. MEDICAL DEVICE TYPE: ONE ADDITIONAL CODE APPLIES, JKA. G.5. PMA/510(K)#: TWO ADDITIONAL CODES APPLY, K213670, K231373. H.3. A DEVICE EVALUATION AND/OR DEVICE HISTORY REVIEW IS ANTICIPATED BUT IS NOT COMPLETE. UPON COMPLETION, A SUPPLEMENTAL REPORT WILL BE FILED.

Description of Event or Problem · 0

IT WAS REPORTED THAT AFTER DRAWING BD VACUTAINER® K2 EDTA (K2E) 5.4MG BLOOD COLLECTION TUBES, A DEFORMED PLASTIC PROJECTION WAS FOUND ON THE INNER TUBE WALL. NO IMPACT WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT AFTER DRAWING BD VACUTAINER® K2 EDTA (K2E) 5.4MG BLOOD COLLECTION TUBES, A DEFORMED PLASTIC PROJECTION WAS FOUND ON THE INNER TUBE WALL. NO IMPACT WAS REPORTED.

Description of Event or Problem · 0

IT WAS REPORTED THAT AFTER DRAWING BD VACUTAINER® K2 EDTA (K2E) 5.4MG BLOOD COLLECTION TUBES, A DEFORMED PLASTIC PROJECTION WAS FOUND ON THE INNER TUBE WALL. NO IMPACT WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2535508 BD VACUTAINER® K2 EDTA (K2E) 5.4MG BLOOD COLLECTION TUBES BLOOD SPECIMEN COLLECTION DEVICE GIM BECTON, DICKINSON & CO. (BROKEN BOW) 3163664 30382903678564

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown