FDA Adverse Event Malfunction Summary report: N

BD INSULIN SYRINGE WITH THE BD ULTRA-FINE NEEDLE

MDR report key: 9584473 · Received January 13, 2020

Report

Report Number
1920898-2019-01539
Event Type
Malfunction
Date Received
January 13, 2020
Date of Event
December 27, 2019
Report Date
January 30, 2020
Manufacturer
BD MEDICAL - DIABETES CARE
Product Code
FMF
UDI-DI
00382908466035
PMA / PMN Number
K024112
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
AZ, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 0

H.6 INVESTIGATION SUMMARY: CUSTOMER RETURNED ONE (1) LOOSE 30GX12.7MM, 0.5ML BD INSULIN SYRINGE. CONSUMER REPORTED FINDING 2 SYRINGES WITH BENT NEEDLES PRIOR TO USE AND FINDING 2 SYRINGES WITH LOOSE HUBS PRIOR TO USE. THE RETURNED SYRINGE WAS EXAMINED, AND IT WAS OBSERVED THAT THE NEEDLE HUB/SHIELD ASSEMBLY WAS SEPARATED FROM THE SYRINGE BARREL; NO DAMAGE TO THE BARREL TIP WAS OBSERVED. NO EVIDENCE OF A BENT NEEDLE WAS OBSERVED ON THE RETURNED SYRINGE. BD WAS ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE (HUB SEPARATES) BUT WAS NOT ABLE TO DUPLICATE OR CONFIRM THE CUSTOMER¿S INDICATED FAILURE (NEEDLE BENT). A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED FOR BATCH # 9140646 ALL INSPECTIONS WERE PERFORMED PER THE APPLICABLE OPERATIONS QC SPECIFICATIONS. THERE WAS ONE (1) NOTIFICATION (B)(4) NOTED FOR RAISED HUBS. THERE WAS ONE (1) NOTIFICATION (B)(4) NOTED THAT DID NOT PERTAIN TO THE COMPLAINT. A VISUAL EVALUATION OF PHOTO FOUND (1) SYRINGE WITH NO NEEDLE ASSEMBLY ATTACHED. THERE DID NOT APPEAR TO BE ANY DAMAGE TO THE TIP OF THE BARREL, OR ANYWHERE ON THE SYRINGE. THERE WAS NO HUB INSIDE OF THE SHIELD. PROCESS SUMMARY: AUTOMATIC SYRINGE ASSEMBLY MACHINE, WHICH FEEDS 0.5ML, SYRINGE COMPONENTS (BARREL, STOPPER, PLUNGER, NEEDLE ASSEMBLY & CAP) AND ASSEMBLES THESE COMPONENTS. THIS MACHINE CONSISTS OF A BARREL CLEANING DIAL, LUBRICATION DIAL, PLUNGER/STOPPER ASSEMBLY DIAL, SYRINGE ASSEMBLY DIAL, AND VARIOUS INSPECTIONS AND TRANSFER DIALS. ROOT CAUSE: NOTIFICATION (B)(4) WAS CREATED RAISED HUBS AT JA ASSEMBLY MACHINE. THERE WAS A BAD VALUE ON THE EJECT SHOOT. CORRECTIVE ACTION: VALVE ON EJECT GATE WAS REPLACED. COMPLAINTS RECEIVED FOR THIS DEVICE AND REPORTED CONDITION WILL CONTINUE TO BE TRACKED AND TRENDED. INFORMATION WILL BE CAPTURED ON TREND REPORTS AND MONITORED.

Description of Event or Problem · 0

IT WAS REPORTED THAT BD INSULIN SYRINGE WITH THE BD ULTRA-FINE¿ NEEDLE HAD LOOSE HUBS. THIS OCCURRED ON 2 OCCASIONS DURING USE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: MATERIAL NO. 328466, BATCH NO. 9140646. IT WAS REPORTED THAT 2 SYRINGES HAD BENT NEEDLES PRIOR TO USE AND 2 OTHER SYRINGES HAD LOOSE HUBS. VERBATIM: CONSUMER REPORTED FINDING 2 SYRINGES WITH BENT NEEDLES PRIOR TO USE AND FINDING 2 SYRINGES WITH LOOSE HUBS PRIOR TO USE. STATED, WAS NOT ABLE TO USE SYRINGES FOR INJECTIONS.

Additional Manufacturer Narrative · 1

DATE OF EVENT: UNKNOWN. THE DATE RECEIVED BY MANUFACTURER HAS BEEN USED FOR THIS FIELD. 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 INSULIN SYRINGE WITH THE BD ULTRA-FINE¿ NEEDLE HAD LOOSE HUBS. THIS OCCURRED ON 2 OCCASIONS DURING USE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: MATERIAL NO. 328466, BATCH NO. 9140646. IT WAS REPORTED THAT 2 SYRINGES HAD BENT NEEDLES PRIOR TO USE AND 2 OTHER SYRINGES HAD LOOSE HUBS. VERBATIM: CONSUMER REPORTED FINDING 2 SYRINGES WITH BENT NEEDLES PRIOR TO USE AND FINDING 2 SYRINGES WITH LOOSE HUBS PRIOR TO USE. STATED, WAS NOT ABLE TO USE SYRINGES FOR INJECTIONS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
47536 BD INSULIN SYRINGE WITH THE BD ULTRA-FINE NEEDLE PISTON SYRINGE FMF BD MEDICAL - DIABETES CARE 328466 9140646 00382908466035

Patients

Seq Age Sex Outcome Treatment
1 Other