MAUDE Adverse Event Report: BECTON, DICKINSON & CO. (BROKEN BOW) BD MICROTAINER MAP MICROTUBE FOR AUTOMATED PROCESS K2 EDTA 1.0 MG; BLOOD SPECIMEN COLLECTION DEVICE

Model Number 363706

Device Problem Expiration Date Error (2528)

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

Event Date 03/12/2021

Event Type  malfunction  

Manufacturer Narrative

Investigation summary: bd had not received samples, but 1 photos were provided for investigation.The photos were reviewed and the indicated failure mode for damaged label with the incident lot was observed.Additionally, the retention shelf pack label was inspected with no damage being seen.Based on a review of the device history record for the incident lot, all product specifications and requirements for lot release were met.There were no related quality issues during manufacturing of the product.

Event Description

It was reported when using the bd microtainer® map microtube for automated process k2 edta 1.0 mg there was no label or missing label information.The following information was provided by the initial reporter.The customer stated "this is a report about a labeling issue; the label was damaged/detached.".

• Brand Name: BD MICROTAINER MAP MICROTUBE FOR AUTOMATED PROCESS K2 EDTA 1.0 MG
• Type of Device: BLOOD SPECIMEN COLLECTION DEVICE
• Manufacturer (Section D): BECTON, DICKINSON & CO. (BROKEN BOW); 150 south 1st avenue; broken bow NE 68822
• Manufacturer (Section G): BECTON, DICKINSON & CO. (BROKEN BOW); 150 south 1st avenue; broken bow NE 68822
• Manufacturer Contact: brett wilko ; 9450 south state street; sandy, UT 84070 ; 8015296192
• MDR Report Key: 11603546
• MDR Text Key: 245514894
• Report Number: 1917413-2021-00238
• Device Sequence Number: 1
• Product Code: JKA
• UDI-Device Identifier: 50382903637060
• UDI-Public: 50382903637060
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K093972
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,other,user facility
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 03/12/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/01/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Other
• Device Expiration Date: 02/28/2022
• Device Model Number: 363706
• Device Catalogue Number: 363706
• Device Lot Number: 0230172
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 03/12/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 08/17/2020
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1