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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BECTON DICKINSON AND COMPANY SYRINGE TUBERCU 27GX1/2 1CC SYRINGE, PISTON

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BECTON DICKINSON AND COMPANY SYRINGE TUBERCU 27GX1/2 1CC SYRINGE, PISTON Back to Search Results
Lot Number N/A
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problem Insufficient Information (4580)
Event Date 09/13/2021
Event Type  Death  
Event Description
Patient husband reported that patient deceased on (b)(6) 2021.
 
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Brand NameSYRINGE TUBERCU 27GX1/2 1CC
Type of DeviceSYRINGE, PISTON
Manufacturer (Section D)
BECTON DICKINSON AND COMPANY
1 becton dr
franklin lakes NJ 07417
MDR Report Key12496091
MDR Text Key272439185
Report NumberMW5104053
Device Sequence Number1
Product Code FMF
Combination Product (y/n)Y
Reporter Country CodeUS
Number of Events Reported1
Summary Report (Y/N)N
Report Source Voluntary
Reporter Occupation Patient Family Member or Friend
Type of Report Initial
Report Date 09/16/2021
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received09/17/2021
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? No
Device Operator
Device Lot NumberN/A
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? No
Was the Report Sent to FDA?
Event Location No Information
Was Device Evaluated by Manufacturer?
Is the Device Single Use?
Is This a Reprocessed and Reused Single-Use Device?
Type of Device Usage

Patient Treatment Data
Date Received: 09/17/2021 Patient Sequence Number: 1
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