FDA Adverse Event Malfunction Summary report: N

BD PYXIS¿ MEDBANK TOWER

MDR report key: 23494624 · Received November 7, 2025

Report

Report Number
2016493-2025-131065
Event Type
Malfunction
Date Received
November 7, 2025
Date of Event
July 29, 2024
Report Date
October 28, 2025
Manufacturer
CAREFUSION 303, INC.
Product Code
BRY
UDI-DI
10885403517167
PMA / PMN Number
EXEMPT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OH, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THIS MDR IS BEING SUBMITTED AS PART OF A RETROSPECTIVE REVIEW OF RECORDS DATING JANUARY 2022-DECEMBER 5, 2024, UNDER CAPA 10308384. THE LATE SUBMISSION OF THIS REPORT IS JUSTIFIED BY THE THOROUGH AND DETAILED NATURE OF THE RETROSPECTIVE REVIEW PROCESS. THIS PROCESS WAS ESSENTIAL TO ACCURATELY CAPTURE ALL RELEVANT DATA AND ENSURE THE INTEGRITY OF OUR REPORTING. WE HAVE INCLUDED THE CAPA REFERENCE FOR THE RETROSPECTIVE REVIEW IN THE ADDITIONAL MANUFACTURER NARRATIVE SECTION OF THE FDA FORM 3500A, AS RECOMMENDED. A REVIEW OF THE COMPLAINT HISTORY FOR SN (B)(6) WAS PERFORMED IN SALESFORCE WHICH DID NOT LOCATE SIMILAR COMPLAINTS WITH THE SAME FAILURE MODE FOR THIS SERIAL NUMBER. A REVIEW OF THE DEVICE HISTORY RECORD FOR SN (B)(6) WAS PERFORMED FROM THE DATE OF MANUFACTURE, 22-NOV-2023 AND CONFIRMED THAT THIS DEVICE WAS NOT PREVIOUSLY RETURNED FOR SERVICING AND THERE WERE NO PRODUCTION FAILURES WHICH CORRELATES TO THE CUSTOMER REPORTED ISSUE. UPON INVESTIGATION OF THE ACTUAL DEVICE USED IN THIS INCIDENT, IT WAS DETERMINED THAT THE INCORRECT QUANTITY WAS ENTERED WHEN ISSUING CLONAZEPAM 0.5 MG TABLET. A TECHNICAL SUPPORT SPECIALIST WALKED THE CUSTOMER THROUGH CYCLE COUNTING THE ITEM TO ADJUST THE QOH. THE SYSTEM FUNCTIONED AS INTENDED AFTER THE TECHNICAL SUPPORT SPECIALIST TROUBLESHOT THE DEVICE.

Description of Event or Problem · 0

IT WAS REPORTED BY THE CUSTOMER THAT A BD PYXIS MEDBANK SYSTEM HAD AN INCORRECT QUANTITY ENTERED WHEN ISSUING CLONAZEPAM 0.5 MG TABLET. THERE WERE NO ADVERSE EVENTS OR INJURIES REPORTED BASED ON THIS INCIDENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1873479 BD PYXIS¿ MEDBANK TOWER AUTOMATED DISPENSING CABINET BRY CAREFUSION 303, INC. 1145-00 10885403517167

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown