BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BECTON DICKINSON BLOOD COLLECTION NEEDLE

    MDR report key: 4093081 · Received September 10, 2014

    Report

    Report Number
    MW5038180
    Event Type
    Malfunction
    Date Received
    September 10, 2014
    Date of Event
    September 9, 2014
    Report Date
    September 10, 2014
    Manufacturer
    BECTON DICKINSON
    Product Code
    JKA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OK, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    SAFETY DEVICE - FOR NEEDLE BROKE OFF. BD VACUTAINER NEEDLE - LOT# 4149797. EXP 05/01/2019. PHLEBOTOMIST DREW PT. AFTER REMOVING NEEDLE FROM PT'S ARM PHLEBOTOMIST WENT TO ENGAGE SAFETY AND SAFETY BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    559631 BECTON DICKINSON BLOOD COLLECTION NEEDLE VACUTAINER NEEDLE ECLIPSE JKA BECTON DICKINSON 368607 4149797

    Patients

    Seq Age Sex Outcome Treatment
    1