BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD VACUTAINER® EDTA 2K

    MDR report key: 7475752 · Received May 1, 2018

    Report

    Report Number
    1917413-2018-01200
    Event Type
    Malfunction
    Date Received
    May 1, 2018
    Date of Event
    July 14, 2017
    Report Date
    June 11, 2018
    Manufacturer
    BECTON, DICKINSON & CO.
    Product Code
    JKA
    PMA / PMN Number
    K981013
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    MEDICAL DEVICE TYPE: CORRECTED TO JKA. PMA / 510(K)#: CORRECTED TO K981013.

    Additional Manufacturer Narrative · 1

    BD HAD NOT RECEIVED SAMPLES OR PHOTOS FROM THE CUSTOMER FACILITY FOR EVALUATION; THEREFORE, THE INVESTIGATION WAS LIMITED. A REVIEW OF THE MANUFACTURING RECORDS WAS COMPLETED FOR THE INCIDENT LOT AND NO ISSUES WERE IDENTIFIED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT BD VACUTAINER® EDTA 2K "EDTA-367846-UNDER FILL."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    317503 BD VACUTAINER® EDTA 2K BLOOD SPECIMEN COLLECTION DEVICE JKA BECTON, DICKINSON & CO. 6342742

    Patients

    Seq Age Sex Outcome Treatment
    1 Other