MAUDE Adverse Event Report: BECTON, DICKINSON AND COMPANY, BD BIOSCIENCES BD FACS¿ SAMPLE PREP ASSISTANT III; SEE H10

Model Number 647205

Device Problem Fluid/Blood Leak (1250)

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

Event Date 10/20/2021

Event Type  malfunction  

Event Description

It was reported that bd facs¿ sample prep assistant iii was leaking from the wash station.The following information was provided by the initial reporter: was the leak fluid or air? fluid.Was the leak contained within the instrument? no.Was there spray of fluid under pressure? no.What was the fluid that leaked? unknown.Liquid is leaking on the line from the wash station.".

Manufacturer Narrative

Date of event: unknown.Common device name: automated pipetting, diluting and specimen processing workstations for flow cytometric analysis.Medical device expiration date: na.A device evaluation is anticipated but has not yet begun.Upon completion of the investigation, a supplemental report will be filed.

Manufacturer Narrative

H6: investigation summary scope of issue: the scope of issue is limited to part: 647205 spaiii and serial number: (b)(6).Problem statement: customer reported: fluid leak manufacturing defect trend: there are 0 qns related to the reported issue.Date range (date of incident to 12 months back) from 20oct2020 to date 20oct2021 (rolling 12 months).Complaint trend: there are 11 complaints related to the reported complaint.Date range (date of incident to 12 months back) from 20oct2020 to date 20oct2021 (rolling 12 months).Investigation result / analysis: per fse report: liquid is leaking on the line from the wash station.The connector for the inline filter connection was damaged.Replaced damaged coupling.Leakage has been improved by replacing the coupling.After replacement, checked the initialization operation and confirmed that there is no liquid leakage.Service max review: review of related work order# (b)(6), install date: (b)(6) 2016 defective part number: 640521 coupling insert valve work order notes: subject / reported: fluid leak, problem description: fluidic leak, cause: damaged connector, work performed: replaced damaged connector/coupling, solution: replaced damaged connector/coupling.Returned sample evaluation: did not request return of defective parts manufacturing device history record (dhr) review: review of the dhr for serial number: (b)(6) and (b)(6) was reviewed.The instrument met all the manufacturing specifications prior to release.Risk analysis: risk management file part #100245ra, revision 02 was reviewed.Hazard(s) identified? yes, no.Hazard id: 3.1.29.Hazard: environmental biohazard.Severity: 5.Probability: 1.Risk index: 5.Implementation: bd facs sample prep user¿s guide.Risk control:_alarp.Mitigation(s) sufficient yes, no.Root cause: based on the investigation result and the fse¿s report the root cause was a damaged coupling.Conclusion: based on the investigation results and the fse¿s report the complaint was confirmed for the fluid leak h3 other text : see h10.

Event Description

It was reported that bd facs¿ sample prep assistant iii was leaking from the wash station.The following information was provided by the initial reporter: "1.Was the leak fluid or air? fluid.2.Was the leak contained within the instrument? no.3.Was there spray of fluid under pressure? no.4.What was the fluid that leaked? unknown.Liquid is leaking on the line from the wash station.".

• Brand Name: BD FACS¿ SAMPLE PREP ASSISTANT III
• Type of Device: SEE H10
• Manufacturer (Section D): BECTON, DICKINSON AND COMPANY, BD BIOSCIENCES; 2350 qume drive; san jose CA 95131
• Manufacturer (Section G): BECTON, DICKINSON AND COMPANY, BD BIOSCIENCES; 2350 qume drive; san jose CA 95131
• Manufacturer Contact: katie swenson ; 9450 south state street; sandy, UT 84070 ; 8015296192
• MDR Report Key: 12820409
• MDR Text Key: 280953485
• Report Number: 2916837-2021-00441
• Device Sequence Number: 1
• Product Code: PER
• UDI-Device Identifier: 00382906472052
• UDI-Public: 00382906472052
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K131301
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,Distributor
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 02/08/2022

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 Model Number: 647205
• Device Catalogue Number: 647205
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 10/20/2021
• Initial Date FDA Received: 11/16/2021
• Supplement Dates Manufacturer Received: 02/08/2022
• Supplement Dates FDA Received: 02/11/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 03/08/2016
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1