MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP; DYNJ49883I

Catalog Number DYNJ49883I

Device Problem Material Integrity Problem (2978)

Patient Problem Insufficient Information (4580)

Event Date 05/04/2021

Event Type  malfunction  

Manufacturer Narrative

It was reported that "when the surgeon injected, the plunger broke".A new device was used and there was no impact to the procedure.No reported injury, or medical intervention to staff or patient.To date, no information has been received to indicate that a user or a patient experienced a death, serious injury, medical intervention, follow-up care, or other adverse health impact associated with the reported problem/issue.In an abundance of caution, and in response to an fda 483 issued for cfn 1417592 on 22-jan-2024, this medwatch is being filed for the reported problem/issue.If additional relevant information becomes available a supplemental medwatch will be filed.

Event Description

Syringe breaking.

• Type of Device: DYNJ49883I
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 18842243
• MDR Text Key: 337583864
• Report Number: 1423395-2024-00220
• Device Sequence Number: 1
• Product Code: FDE
• UDI-Device Identifier: 40193489469562
• UDI-Public: 40193489469562
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 03/05/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/05/2024
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Catalogue Number: DYNJ49883I
• Device Lot Number: 21BME386
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 05/04/2021
• Was Device Evaluated by Manufacturer?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other