FDA Adverse Event Malfunction Summary report: N

BD ULTRA FINE¿ PEN NEEDLES

MDR report key: 8491262 · Received April 8, 2019

Report

Report Number
9616657-2019-00170
Event Type
Malfunction
Date Received
April 8, 2019
Date of Event
March 18, 2019
Report Date
May 1, 2019
Manufacturer
BECTON, DICKINSON AND CO.
Product Code
FMI
UDI-DI
10885403928659
PMA / PMN Number
K162516
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
FL, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 0

THE FOLLOWING FIELDS HAVE BEEN UPDATED WITH CORRECTIONS: SITE LEGAL NAME (FDA): BECTON, DICKINSON AND CO. ¿ (B)(6) IRELAND MEDICAL DEVICE MANUFACTURER: BECTON, DICKINSON AND CO. ¿ (B)(4) IRELAND. MANUFACTURING LOCATION: BECTON, DICKINSON AND CO. ¿ (B)(4) IRELAND .

Additional Manufacturer Narrative · 0

H.6. INVESTIGATION SUMMARY: NO SAMPLES (INCLUDING PHOTOS) WERE RETURNED THEREFORE THE COMPLAINT COULD NOT BE CONFIRMED AND THE ROOT CAUSE IS UNDETERMINED. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. IF SAMPLES ARE RECEIVED IN THE FUTURE THE COMPLAINT WILL BE REOPENED FOR FURTHER INVESTIGATION. A LOT HISTORY REVIEW WAS CARRIED OUT AND NO RELATED NON CONFORMANCES WERE RAISED IN ASSOCIATION WITH THIS PACKAGED LOT CONCLUDING ALL INSPECTIONS WERE PERFORMED PER THE APPLICABLE OPERATIONS AND MET QC SPECIFICATIONS. AS NO SAMPLES AND/OR PHOTO(S) WERE RECEIVED THE INVESTIGATION CONCLUDED: UNCONFIRMED: BD WAS NOT ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE AS NO SAMPLES OR PHOTOS WERE RETURNED. BASED ON THE ABOVE, NO ADDITIONAL INVESTIGATION AND NO CAPA IS REQUIRED AT THIS TIME.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PEN DID NOT DEPRESS WITH A BD ULTRA FINE¿ PEN NEEDLES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: CONSUMER REPORTED HER PEN WAS NOT ALLOWING HER TO PUSH DOWN. SHE THOUGHT IT WAS HER VICTOZA AND LEVAMIR, SHE FACED THE SAME PROBLEM WITH HER NEW PEN. INCIDENT- (B)(6) 2019. SAMPLE DISCARDED. SHE DOES NOT DO PRIMING SINCE HER INSULIN PEN ARE PREDETERMINED SUPPLY. SHE USES NEW PEN NEEDLE EACH TIME. SHE ALSO REPORTED HAD 80 PEN NEEDLES IN THE BOX AND THAT IS HOW THE PHARMACY SELLS HER TO MEET 3 MONTHS SUPPLY. LOT # 8205674; EXPIRATION DATE- 08-31-2023; ITEM # 320122 FOR BOTH ISSUES.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PEN DID NOT DEPRESS WITH A BD ULTRA FINE¿ PEN NEEDLES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: CONSUMER REPORTED HER PEN WAS NOT ALLOWING HER TO PUSH DOWN. SHE THOUGHT IT WAS HER VICTOZA AND LEVAMIR, SHE FACED THE SAME PROBLEM WITH HER NEW PEN. INCIDENT- (B)(6) 2019. SAMPLE DISCARDED. SHE DOES NOT DO PRIMING SINCE HER INSULIN PEN ARE PREDETERMINED SUPPLY. SHE USES NEW PEN NEEDLE EACH TIME. SHE ALSO REPORTED HAD 80 PEN NEEDLES IN THE BOX AND THAT IS HOW THE PHARMACY SELLS HER TO MEET 3 MONTHS SUPPLY. LOT # 8205674; EXPIRATION DATE- 08-31-2023; ITEM # 320122 FOR BOTH ISSUES.

Additional Manufacturer Narrative · 1

A DEVICE EVALUATION IS ANTICIPATED, BUT HAS NOT YET BEGUN. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE FILED.

Description of Event or Problem · 1

IT WAS REPORTED THAT THE PEN DID NOT DEPRESS WITH A BD ULTRA FINE¿ PEN NEEDLES. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: CONSUMER REPORTED HER PEN WAS NOT ALLOWING HER TO PUSH DOWN. SHE THOUGHT IT WAS HER VICTOZA AND LEVAMIR, SHE FACED THE SAME PROBLEM WITH HER NEW PEN. INCIDENT- ON (B)(6) 2019. SAMPLE DISCARDED. SHE DOES NOT DO PRIMING SINCE HER INSULIN PEN ARE PREDETERMINED SUPPLY. SHE USES NEW PEN NEEDLE EACH TIME. SHE ALSO REPORTED HAD 80 PEN NEEDLES IN THE BOX AND THAT IS HOW THE PHARMACY SELLS HER TO MEET 3 MONTHS SUPPLY. LOT # 8205674; EXPIRATION DATE- 08-31-2023; ITEM # 320122 FOR BOTH ISSUES.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
283304 BD ULTRA FINE¿ PEN NEEDLES HYPODERMIC SINGLE LUMEN NEEDLE FMI BECTON, DICKINSON AND CO. 8205674 10885403928659

Patients

Seq Age Sex Outcome Treatment
1 Other