BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM

    MDR report key: 9913696 · Received April 1, 2020

    Report

    Report Number
    3006948883-2020-00110
    Event Type
    Malfunction
    Date Received
    April 1, 2020
    Date of Event
    March 3, 2020
    Report Date
    April 20, 2020
    Manufacturer
    BD (SUZHOU)
    Product Code
    FOZ
    PMA / PMN Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CH
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    H.6. INVESTIGATION SUMMARY : A DEVICE HISTORY REVIEW WAS CONDUCTED FOR LOT NUMBER 9023814. OUR RECORDS SHOW THAT THIS IS THE ONLY INSTANCE OF THIS ISSUE OCCURRING IN THIS PRODUCTION BATCH. ACCORDING TO THE SAMPLING PLAN APPLIED FOR PRODUCT PERFORMANCE, THIS LOT WAS ACCEPTED AND RELEASED WITHOUT DEFECTS BEING NOTED DURING THE FINAL ASSEMBLY OR VISUAL INSPECTIONS. UNFORTUNATELY A SAMPLE COULD NOT BE OBTAINED FOR EVALUATION AND TESTING. WITHOUT THE ABILITY TO INVESTIGATE THE AFFECTED UNIT OUR QUALITY ENGINEERS WERE UNABLE TO DETERMINE THE ROOT CAUSE FOR THIS COMPLAINT. BD WILL CONTINUE TO MONITOR THIS ISSUE. H3 OTHER TEXT : SEE SECTION H.10.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM PRN CAP WAS DISCOLORED AND "UNGLUED" DURING THE INFUSION PROCESS. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM CHINESE TO ENGLISH: "AROUND 9 O 'CLOCK ON (B)(6) 2020, THE NURSE FOUND THAT THE PRN OF THE INDWELLING NEEDLE WAS DISCOLORED AND UNGLUED IN THE PROCESS OF INFUSION FOR THE PATIENT. REPLACE ANOTHER INDWELLING NEEDLES, THERE IS NO SUCH SITUATION."

    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 BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM PRN CAP WAS DISCOLORED AND "UNGLUED" DURING THE INFUSION PROCESS. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER, TRANSLATED FROM (B)(6) TO ENGLISH: "AROUND 9 O 'CLOCK ON (B)(6) 2020, THE NURSE FOUND THAT THE PRN OF THE INDWELLING NEEDLE WAS DISCOLORED AND UNGLUED IN THE PROCESS OF INFUSION FOR THE PATIENT. REPLACE ANOTHER INDWELLING NEEDLES, THERE IS NO SUCH SITUATION."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    372894 BD INTIMA-II¿ CLOSED IV CATHETER SYSTEM INTRAVASCULAR CATHETER FOZ BD (SUZHOU) 9023814

    Patients

    Seq Age Sex Outcome Treatment
    1 Other