MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP; SYR W/NDLE,INSLN,0.5ML,31GX5/16"

Model Number SYRI005314

Device Problems Contamination (1120); Improper Flow or Infusion (2954)

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

Event Date 01/11/2022

Event Type  malfunction  

Event Description

It was reported that the syringe had foreign particulate and "a lot of wasted product.".

Manufacturer Narrative

It was reported that the syringe had foreign particulate and "a lot of wasted product." no serious injury or adverse impact to a patient or to a user was originally 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.One (1) case of product in new condition was returned for evaluation.Visual and function inspection was unable to confirm the reported problem/issue.Tested samples worked as intended and no foreign particulates were identified.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.If additional relevant information becomes available a supplemental medwatch will be filed.

• Type of Device: SYR W/NDLE,INSLN,0.5ML,31GX5/16"
• 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: 18966406
• MDR Text Key: 339089419
• Report Number: 1417592-2024-00194
• Device Sequence Number: 1
• Product Code: FMF
• UDI-Device Identifier: 30193489008634
• UDI-Public: 30193489008634
• 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: 03/23/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/24/2024
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Model Number: SYRI005314
• Device Lot Number: 89720120001
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 01/11/2022
• Was Device Evaluated by Manufacturer?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other