BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD MICRO-FINE ULTRA¿ INSULIN PEN NEEDLE

    MDR report key: 8518529 · Received April 16, 2019

    Report

    Report Number
    9616656-2019-00361
    Event Type
    Malfunction
    Date Received
    April 16, 2019
    Date of Event
    March 28, 2019
    Report Date
    May 28, 2019
    Manufacturer
    BECTON DICKINSON AND CO.
    Product Code
    FMI
    UDI-DI
    00382903251056
    PMA / PMN Number
    K131358
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    INVESTIGATION: ONE PHOTO OF A 31G X 8MM PEN NEEDLE SAMPLE WAS RETURNED FROM LOT. NO. 8122822, CAT. NO. 325105. VISUAL EXAMINATION WAS CARRIED OUT ON THE RETURNED PHOTO AND A CANNULA THROUGH SHIELD AND COVER WAS OBSERVED. 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. ROOT CAUSE OF THIS ISSUE WAS INCORRECT LOADING OF THE SHIELD TO THE HUB AT THE SHIELDING STATION.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT BD MICRO-FINE ULTRA¿ INSULIN PEN NEEDLE PIERCED THROUGH THE SAFETY SHIELD. NO SERIOUS INJURY OR MEDICAL INTERVENTION WAS REPORTED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: NEEDLE THROUGH SAFETY SHIELD.

    Additional Manufacturer Narrative · 1

    A DEVICE EVALUATION AND/OR DEVICE HISTORY REVIEW IS ANTICIPATED, BUT IS NOT COMPLETE. UPON COMPLETION, A SUPPLEMENTAL REPORT WILL BE FILED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT BD MICRO-FINE ULTRA¿ INSULIN PEN NEEDLE PIERCED THROUGH THE SAFETY SHIELD. NO SERIOUS INJURY OR MEDICAL INTERVENTION WAS REPORTED. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: NEEDLE THROUGH SAFETY SHIELD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    310108 BD MICRO-FINE ULTRA¿ INSULIN PEN NEEDLE PEN NEEDLE FMI BECTON DICKINSON AND CO. 8122822 00382903251056

    Patients

    Seq Age Sex Outcome Treatment
    1 Other