BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD VACUTAINER® SAFETY-LOK¿ BCS WITH PRE-ATTACHED HOLDER

    MDR report key: 7058818 · Received November 27, 2017

    Report

    Report Number
    1024879-2017-00787
    Event Type
    Malfunction
    Date Received
    November 27, 2017
    Date of Event
    December 10, 2015
    Report Date
    November 1, 2017
    Manufacturer
    BECTON, DICKINSON & CO., (BD)
    Product Code
    JKA
    PMA / PMN Number
    K980414
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. RESULTS: A SAMPLE WAS NOT RETURNED FOR EVALUATION. A REVIEW OF THE DEVICE HISTORY RECORD REVEALED NO IRREGULARITIES DURING THE MANUFACTURE OF THE REPORTED LOT # 5162999. CONCLUSION: WITHOUT A SAMPLE, AN ABSOLUTE ROOT CAUSE FOR THIS INCIDENT CANNOT BE DETERMINED AS BD WAS NOT ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE MODE.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT IV NEEDLE PROTECTIVE SHIELD FELL OFF AFTER REMOVING BD VACUTAINER® SAFETY-LOK¿ BCS WITH PRE-ATTACHED HOLDER, 21G 7IN TUBE FROM INDIVIDUAL PACKAGING. NO INJURY OR MEDICAL INTERVENTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    838764 BD VACUTAINER® SAFETY-LOK¿ BCS WITH PRE-ATTACHED HOLDER BLOOD COLLECTION NEEDLE JKA BECTON, DICKINSON & CO., (BD) 5162999

    Patients

    Seq Age Sex Outcome Treatment
    1 Other