MAUDE Adverse Event Report: BD (SUZHOU) INTIMA-II Y 24GAX0.75IN PRN EC SLM NPVC; CATHETER

Catalog Number 383083

Device Problem Leak/Splash (1354)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 11/26/2020

Event Type  malfunction  

Manufacturer Narrative

A device evaluation and/or device history review is anticipated, but is not complete.Upon completion, a supplemental report will be filed.(b)(4).

Event Description

It was reported that intima-ii y 24gax0.75in prn ec slm npvc leaked.The following information was provided by the initial reporter: after the patient used the indwelling needle successfully.It was found that the prn was leaking.After replacing the screw cap, no such issue occurred and the liquid injected normally.

Event Description

It was reported that intima-ii y 24gax0.75in prn ec slm npvc leaked.The following information was provided by the initial reporter: after the patient used the indwelling needle sucessfully.It was found that the prn was leaking.After replacing the screw cap, no such issue occurred and the liquid injected normally.

Manufacturer Narrative

H.6.Investigation: a device history review was conducted for lot number 9323923.Our records show that this is the only instance of this issue occurring in this production batch.According to the sampling plan applied for product performance, this lot was accepted and released without defects being noted during the final assembly or visual inspections.A sample could not be obtained for evaluation and testing; in lieu of the affected device, functional testing was performed on retention samples for this lot, the results of these show that the tested units performed within product specifications.Unfortunately without the ability to investigate the affected unit our quality engineers were unable to determine the root cause for this complaint.H3 other text : see h.10.

• Brand Name: INTIMA-II Y 24GAX0.75IN PRN EC SLM NPVC
• Type of Device: CATHETER
• Manufacturer (Section D): BD (SUZHOU); no. 5 baiyu road; suzhou industrial park; suzhou
• MDR Report Key: 11074355
• MDR Text Key: 227951934
• Report Number: 3006948883-2020-01045
• Device Sequence Number: 1
• Product Code: FOZ
• Combination Product (y/n): N
• PMA/PMN Number: NA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,other,user facility
• Type of Report: Initial,Followup
• Report Date: 12/30/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Other
• Device Expiration Date: 12/14/2022
• Device Catalogue Number: 383083
• Device Lot Number: 9323923
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 11/28/2020
• Initial Date FDA Received: 12/27/2020
• Supplement Dates Manufacturer Received: 12/30/2020
• Supplement Dates FDA Received: 01/15/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1