MAUDE Adverse Event Report: BECTON DICKINSON SYRINGE 5ML SALINE FILL CHINA SP; SALINE, VASCULAR ACCESS FLUSH

Catalog Number 306594

Device Problem Short Fill (1575)

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

Event Date 08/12/2023

Event Type  malfunction  

Event Description

The patient was admitted for mixed hemorrhoids and was flushed using a prefilled catheter flosser at 0830 hours on (b)(6) 2023 when an insufficient amount of fluid was found, which did not harm the patient and was replaced immediately.

Manufacturer Narrative

(b)(4): initial mdr submission.A follow up mdr will be submitted if additional information becomes available.Device problem code - a140303 - short fill.Patient problem code: f26 ¿ no health consequences or impact.

Event Description

No additional information received.The patient was admitted for mixed hemorrhoids and was flushed using a prefilled catheter flosser at 0830 hours on (b)(6) 2023 when an insufficient amount of fluid was found, which did not harm the patient and was replaced immediately.

Manufacturer Narrative

(b)(4) follow up: a device history record review was completed by our quality engineer team for provided material number 306594 and lot number 2095391.The review did not reveal any detected abnormalities during the production process that could have contributed to this defect and all quality tests were found to be within specification.As a sample was unavailable for return, a thorough sample investigation could not be completed.Based on the investigation results, an exact cause for this incident could not be identified.Should you again experience any problems with our product we would appreciate the opportunity to conduct a thorough analysis.There are quality controls currently in place to detect this type of defect during the production process.Further action has not been determined necessary at this time.

• Brand Name: SYRINGE 5ML SALINE FILL CHINA SP
• Type of Device: SALINE, VASCULAR ACCESS FLUSH
• Manufacturer (Section D): BECTON DICKINSON; 1 becton drive; franklin lakes NJ 07417
• Manufacturer (Section G): BD MEDICAL (BD WEST) MEDICAL SURGICAL; 1852 10th avenue; columbus NE 68601
• Manufacturer Contact: helen cox ; 75 north fairway drive; vernon hills, IL 60061 ; 8473935694
• MDR Report Key: 17952742
• MDR Text Key: 326246590
• Report Number: 1911916-2023-00780
• Device Sequence Number: 1
• Product Code: NGT
• UDI-Device Identifier: 30382903065944
• UDI-Public: (01)30382903065944
• Combination Product (y/n): N
• Reporter Country Code: CH
• PMA/PMN Number: UNK
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 11/01/2023

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: Health Professional
• Device Catalogue Number: 306594
• Device Lot Number: 2095391
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 10/12/2023
• Initial Date FDA Received: 10/17/2023
• Supplement Dates Manufacturer Received: 11/01/2023
• Supplement Dates FDA Received: 10/31/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 04/05/2022
• Is the Device Single Use?: Yes
• Type of Device Usage: Initial
• Patient Sequence Number: 1