BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ATELLICA VTR SYRINGES

    MDR report key: 21551954 · Received March 7, 2025

    Report

    Report Number
    2028807-2025-00003
    Event Type
    Malfunction
    Date Received
    March 7, 2025
    Report Date
    March 7, 2025
    Manufacturer
    WESTMED LLC
    Product Code
    CBT
    UDI-DI
    10889483479483
    PMA / PMN Number
    EXEMPT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PO
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    THE PRODUCT INVOLVED IN THE REPORT HAS NOT BEEN RETURNED FOR EVALUATION. A REVIEW OF THE DEVICE HISTORY RECORD IS IN-PROGRESS. ALL INFORMATION REASONABLY KNOWN AS OF 07 MAR 2025 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY SUN MED HOLDINGS LLC. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO SUN MED HOLDINGS LLC. SUN MED HOLDINGS LLC. HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE SUN MED HOLDINGS COMPLAINT DATABASE AND IDENTIFIED AS (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT AN SUN MED HOLDINGS LLC. PRODUCT IS DEFECTIVE OR CAUSED SERIOUS INJURY.

    Description of Event or Problem · 0

    SUNMED HOLDINGS LLC. RECEIVED A SINGLE REPORT THAT REFERENCED THREE DIFFERENT INCIDENCES, WHICH WERE ASSOCIATED WITH SEPARATE UNITS, INVOLVING THREE DIFFERENT PATIENTS. THIS IS THE SECOND OF THREE REPORTS. REFER TO 2028807-2025-00002 FOR THE FIRST REPORT, REFER TO 2028807-2025-00004 FOR THE THIRD REPORT. IT WAS REPORTED, THE SYRINGES WERE UNABLE TO ADEQUATELY RETAIN ARTERIAL BLOOD, DUE TO POOR SEALING OF THE PLUNGER WHICH RESULTED IN: BLOOD LOSS THROUGH THE PLUNGER; THE EFFICIENCY OF COLLECTIONS; DIFFICULTY IN CARRYING OUT ARTERIAL BLOOD SAMPLING, BLOOD LEAKING ONTO SURFACES AND INTO THE ENVIRONMENT. THERE WAS NO REPORTED INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1139923 ATELLICA VTR SYRINGES 3ML VENTED, LUER LOCK SYRINGE, BALANCED HEPARIN, VENTED TIP CAP, CBT WESTMED LLC 11561350 456820 10889483479483

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown