BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD 3ML SYRINGE

    MDR report key: 3820566 · Received May 15, 2014

    Report

    Report Number
    MW5036158
    Event Type
    Malfunction
    Date Received
    May 15, 2014
    Date of Event
    May 9, 2014
    Report Date
    May 14, 2014
    Manufacturer
    B-D
    Product Code
    FMF
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    UPON COMPLETION OF ZOSYN (IN 3 ML BD SYRINGE FROM PHARMACY) WHILE DISCONNECTING THE MED SYRINGE FROM THE MED LINE, THE INSIDE HUB OF THE SYRINGE BROKE OFF IN THE MED LINE MAKING IT UNABLE TO FLUSH THE REMAINDER 0.4 ML (FROM A TOTAL MED VOLUME OF 1.25 ML) OF MEDICATION. REMAINDER OF MED ORDERED BY PHARMACIST AND WILL BE ADMINISTERED UPON RECEIPT OF MEDICATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    291382 BD 3ML SYRINGE SYRINGE FMF B-D

    Patients

    Seq Age Sex Outcome Treatment
    1 1 MO PIPERACILLIN