MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP; SYR W/NDLE,HYPODERM,TB,27GX 1/2", 1M

Model Number SYR101272H

Device Problems Fluid/Blood Leak (1250); Detachment of Device or Device Component (2907)

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

Event Date 02/18/2023

Event Type  malfunction  

Manufacturer Narrative

It was reported that a needle detached from the syringe during an injection of heparin.The needle remained in the patient's are following detachment and, reportedly, heparin went into the patient and the nurses' eyes.The needle was removed from the patient.Both the patient and the nurse were evaluated following the incident and no serious injury or adverse impact to either individual 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.No sample was returned for evaluation and testing was performed using retained product from the reported lot.Visual and functional testing was unable to reproduce or confirm 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.If additional relevant information becomes available a supplemental medwatch will be filed.

Event Description

It was reported that a needle detached from the syringe during an injection.

• Type of Device: SYR W/NDLE,HYPODERM,TB,27GX 1/2", 1M
• 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: 18966663
• MDR Text Key: 339090182
• Report Number: 1417592-2024-00212
• Device Sequence Number: 1
• Product Code: FMF
• UDI-Device Identifier: 10080196448814
• UDI-Public: 10080196448814
• 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: 03/24/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/25/2024
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Model Number: SYR101272H
• Device Lot Number: 989722040001
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 03/14/2023
• 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