MAUDE Adverse Event Report: PHILIPS MEDICAL SYSTEMS ORAL SYRINGE; ORAL ENTERNAL SYRINGE

Model Number 1062683

Device Problem Device Contamination with Chemical or Other Material (2944)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Type  malfunction  

Manufacturer Narrative

A follow up report will be submitted once the investigation is complete.

Event Description

The customer stated there was a small piece of plastic in the syringe.Customer stated they received this in 2015.There was no reported patient impact.

• Brand Name: ORAL SYRINGE
• Type of Device: ORAL ENTERNAL SYRINGE
• Manufacturer (Section D): PHILIPS MEDICAL SYSTEMS; 3000 minuteman road; andover MA 01810
• Manufacturer Contact: betty harris ; 3000 minuteman road; andover, MA 01810
• MDR Report Key: 5477577
• MDR Text Key: 39675320
• Report Number: 1218950-2016-01364
• Device Sequence Number: 1
• Product Code: EIB
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K100099
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: user facility
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 02/09/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 03/03/2016
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Nurse
• Device Model Number: 1062683
• Device Lot Number: 2014-41
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/16/2016
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 02/09/2016
• Was Device Evaluated by Manufacturer?: Yes
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1