BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD VACUTAINER® SST¿ BLOOD COLLECTION TUBES

    MDR report key: 9202449 · Received October 17, 2019

    Report

    Report Number
    1024879-2019-01821
    Event Type
    Malfunction
    Date Received
    October 17, 2019
    Date of Event
    October 1, 2019
    Report Date
    November 14, 2019
    Manufacturer
    BECTON, DICKINSON & CO., (BD)
    Product Code
    JKA
    UDI-DI
    50382903679862
    PMA / PMN Number
    BK050036
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    INVESTIGATION SUMMARY: BD HAD NOT RECEIVED SAMPLES OR PHOTOS FROM THE CUSTOMER FACILITY FOR EVALUATION. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR THE INCIDENT LOT AND, BASED ON THIS REVIEW, ALL PRODUCT SPECIFICATIONS AND REQUIREMENTS FOR LOT RELEASE WERE MET; THERE WERE NO RELATED QUALITY NON-CONFORMANCES DURING MANUFACTURING OF THE PRODUCT.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT BD VACUTAINER® SST¿ BLOOD COLLECTION TUBES HAD INCORRECT LABEL INFORMATION AND FOREIGN MATTER. THIS WAS DISCOVERED BEFORE USE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: MATERIAL NO. 367986, BATCH NO. 9143647. IT WAS REPORTED THAT A EXPIRED TUBE WAS INCLUDED IN THE SHELF PACK. AN EXPIRED TUBE WAS FOUND IN THE SHELF PACK, ALSO HAD A DIFFERENT LOT NUMBER. IT WAS CAUGHT BEFORE USE. UPDATE: TUBE HAS BLOOD IN IT.

    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 VACUTAINER® SST¿ BLOOD COLLECTION TUBES HAD INCORRECT LABEL INFORMATION AND FOREIGN MATTER. THIS WAS DISCOVERED BEFORE USE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: MATERIAL NO. 367986. BATCH NO. 9143647. IT WAS REPORTED THAT A EXPIRED TUBE WAS INCLUDED IN THE SHELF PACK. AN EXPIRED TUBE WAS FOUND IN THE SHELF PACK, ALSO HAD A DIFFERENT LOT NUMBER. IT WAS CAUGHT BEFORE USE. UPDATE: TUBE HAS BLOOD IN IT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1000130 BD VACUTAINER® SST¿ BLOOD COLLECTION TUBES BLOOD SPECIMEN COLLECTION DEVICE JKA BECTON, DICKINSON & CO., (BD) 9143647 50382903679862

    Patients

    Seq Age Sex Outcome Treatment
    1 Other