MAUDE Adverse Event Report: BECTON DICKINSON SYRINGE 5ML SALINE FILL CHINA SP; SALINE, VASCULAR ACCESS FLUSH

Catalog Number 306594

Device Problem Break (1069)

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

Event Date 02/21/2024

Event Type  malfunction  

Event Description

"instrument use time:(b)(6) 2024, 13:04:05.Purpose of use:sealing catheters for patient infusions.Basis of use:pre-flush catheter flusher.Condition of use:fracture of the end of the pre-flush catheter flusher's injection panel.Adverse event:fracture of the push panel at the end of the pre-flush catheterization device, resulting in inability to push the device.Impact on victims:none.Time to treatment:(b)(6) 2024, 13:05:00.Treatment taken:replacement of pre-flush catheter flushers.Time to improvement of adverse event:(b)(6) 2024, 13:05:15.Combined use:none.Hospital:(b)(6) hospital".

Manufacturer Narrative

(b)(4): initial mdr submission.A follow up mdr will be submitted if additional information, a device evaluation, or a device history review is completed.

Manufacturer Narrative

(b)(4).Follow up.A device history record review was completed by our quality engineer team for provided material number 306594 and lot number 3271736.The review did not reveal any detected abnormalities during the production process that could have contributed to this defect and all quality tests were found to be within specification.As a sample was unavailable for return, a thorough sample investigation could not be completed.Based on the investigation results, an exact cause for this incident could not be identified.Should you again experience any problems with our product we would appreciate the opportunity to conduct a thorough analysis.There are quality controls currently in place to detect this type of defect during the production process.Further action has not been determined necessary at this time.H3 other text : see h10 narrative.

Event Description

No additional information received "instrument use time:(b)(6) 2024 13:04:05.Purpose of use:sealing catheters for patient infusions.Basis of use:pre-flush catheter flusher.Condition of use:fracture of the end of the pre-flush catheter flusher's injection panel.Adverse event:fracture of the push panel at the end of the pre-flush catheterization device, resulting in inability to push the device.Impact on victims:none.Time to treatment:(b)(6) 2024 13:05:00.Treatment taken:replacement of pre-flush catheter flushers.Time to improvement of adverse event:(b)(6) 2024 13:05:15.Combined use:none.Hospital: (b)(6) hospital".

• Brand Name: SYRINGE 5ML SALINE FILL CHINA SP
• Type of Device: SALINE, VASCULAR ACCESS FLUSH
• Manufacturer (Section D): BECTON DICKINSON; 1 becton drive; franklin lakes NJ 07417
• Manufacturer (Section G): BD MEDICAL (BD WEST) MEDICAL SURGICAL; 1852 10th avenue; columbus NE 68601
• Manufacturer Contact: helen cox (mdr) ; 75 north fairway drive; vernon hills, IL 60061 ; 8473935694
• MDR Report Key: 18895269
• MDR Text Key: 337773727
• Report Number: 1911916-2024-00181
• Device Sequence Number: 1
• Product Code: NGT
• UDI-Device Identifier: 30382903065944
• UDI-Public: (01)30382903065944
• Combination Product (y/n): N
• Reporter Country Code: CH
• PMA/PMN Number: K161552
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 04/18/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/13/2024
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 306594
• Device Lot Number: 3271736
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 04/18/2024
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 09/28/2023
• Is the Device Single Use?: Yes
• Type of Device Usage: Initial
• Patient Sequence Number: 1