MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP; DBD-CARDIOVASCULAR PACK

Model Number DYNJ46683D

Device Problems Crack (1135); Fluid/Blood Leak (1250)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 01/22/2021

Event Type  malfunction  

Manufacturer Narrative

It was reported that a syringe component was cracked.Reportedly, the crack was identified as a physician as flushing a sheath with the syringe.The syringe was filled with saline and blood at the time of the incident and the physician was sprayed with the fluid.The physician was wearing ppe and he changed/replaced his scrubs and soiled ppe and then washed in a sink.No diagnostic exams or post-exposure treatment was reported.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.A photo was provided for review and the syringe in the photo was observed to have cracked from just above the 1ml line to the 9ml line.No physical sample was returned for evaluation.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

It was reported that a syringe component was cracked.

• Type of Device: DBD-CARDIOVASCULAR PACK
• Manufacturer (Section D): MEDLINE INDUSTRIES, LP; three lakes drive; northfield IL 60093 2753
• Manufacturer Contact: nigel vilches ; three lakes drive; northfield, IL 60093-2753
• MDR Report Key: 18871003
• MDR Text Key: 337268853
• Report Number: 1423395-2024-00226
• Device Sequence Number: 1
• Product Code: OEZ
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: User Facility
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 03/08/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/08/2024
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Model Number: DYNJ46683D
• Device Lot Number: 20IDC168
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 01/25/2021
• 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
• Patient Age: 25 YR
• Patient Sex: Male
• Patient Weight: 73 KG