BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD ULTRA-FINE¿ MINI PEN NEEDLES 5MM (3/16¿) 31G

    MDR report key: 8505769 · Received April 11, 2019

    Report

    Report Number
    9616656-2019-00341
    Event Type
    Malfunction
    Date Received
    April 11, 2019
    Date of Event
    March 19, 2019
    Report Date
    March 26, 2019
    Manufacturer
    BECTON DICKINSON AND CO.
    Product Code
    FMI
    UDI-DI
    00382903201198
    PMA / PMN Number
    K162516
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    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. INVESTIGATION CONCLUSION: BD WAS NOT ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE AS NO SAMPLES OR PHOTOS WERE RETURNED. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. INFORMATION WILL BE CAPTURED ON TREND REPORTS AND MONITORED MONTHLY. OUR BUSINESS TEAM REGULARLY REVIEWS THE COLLECTED DATA FOR IDENTIFICATION OF EMERGING TRENDS. ROOT CAUSE DESCRIPTION: ROOT CAUSE CANNOT BE DETERMINED AT THIS TIME AS THE ISSUE IS UNCONFIRMED AS NO SAMPLES OR PHOTOS WERE RETURNED. RATIONALE: BASED ON THE INVESTIGATION, NO ADDITIONAL INVESTIGATION AND NO CAPA IS REQUIRED AT THIS TIME.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING USE OF THE BD ULTRA-FINE¿ MINI PEN NEEDLES 5MM (3/16¿) 31G THE NEEDLE BROKE OFF INTO SITE DURING INJECTION. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: MATERIAL NO. 320119, BATCH NO. 8233893. IT WAS REPORTED THAT NEEDLE BROKE OFF INTO SITE DURING INJECTION. VERBATIM: CONSUMER REPORTED THAT THE NEEDLE BROKE OFF INTO INJECTION SITE DURING INJECTION, STATED THAT SHE NOTICED THE NEEDLE MISSING AFTER INJECTION. CONSUMER DOES NOT RE-USE, DOES ROTATE THE INJECTION SITE, PROBLEM OCCURRED ON (B)(6) 2019. LOT # 8233893, PRODUCT # 320119, EXP 08-31-2023. NO MEDICAL ATTENTION, NO INJURY, PAIN OR DISCOMFORT. SAMPLES HAVE BEEN DISCARDED, SENDING PRODUCT VOUCHER. ADVISED CONSUMER TO CONTACT US WITH ANY UPDATES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    298619 BD ULTRA-FINE¿ MINI PEN NEEDLES 5MM (3/16¿) 31G PEN NEEDLE FMI BECTON DICKINSON AND CO. 8233893 00382903201198

    Patients

    Seq Age Sex Outcome Treatment
    1 Other