MAUDE Adverse Event Report: BECTON DICKINSON SYRINGE 10ML 21G 1-1/4IN; PISTON SYRINGE

Catalog Number 59006488

Device Problem Device Contamination with Chemical or Other Material (2944)

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

Event Date 09/10/2021

Event Type  malfunction  

Manufacturer Narrative

The manufacturing location for this product is (b)(4).This site is an oem manufacturing site.Therefore, bd corporate headquarters in (b)(4) has been listed and the (b)(4) fda registration number has been used for the manufacture report number.Medical device expiration date: unknown.Device manufacture date: unknown.A device evaluation and/or device history review is anticipated, but is not complete.Upon completion, a supplemental report will be filed.Date of event: unknown.The date received by manufacturer has been used as a default.

Event Description

It was reported that syringe 10ml 21g 1-1/4in contained foreign matter.The following information was provided by the initial reporter: "foreign material in needle hub".

Manufacturer Narrative

D10: device available for eval yes, d10: returned to manufacturer on: 2021-09-14.Investigation summary: a device history review was conducted for lot number 1106282.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.Additionally, a sample was submitted to our facility to aid in investigation.They noted the presence of a foreign material behind the needle hub.This material was gathered and submitted for compositional testing, which identified the material as polypropylene the same material as the needle hub.Our engineers were able to determine that the most likely root cause for this event is related to the manufacturing process of our supplier for this component.H3 other text : see h10.

Event Description

It was reported that syringe 10ml 21g 1-1/4in contained foreign matter.The following information was provided by the initial reporter: "foreign material in needle hub".

• Brand Name: SYRINGE 10ML 21G 1-1/4IN
• Type of Device: PISTON SYRINGE
• Manufacturer (Section D): BECTON DICKINSON; 1 becton drive; franklin lakes NJ 07417
• Manufacturer (Section G): BECTON DICKINSON; 1 becton drive; franklin lakes NJ 07417
• Manufacturer Contact: katie swenson ; 9450 south state street; sandy, UT 84070 ; 8015296192
• MDR Report Key: 12601852
• MDR Text Key: 276192086
• Report Number: 2243072-2021-02473
• Device Sequence Number: 1
• Product Code: FMF
• Combination Product (y/n): N
• Reporter Country Code: KS
• PMA/PMN Number: NA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign,User Facility
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 11/12/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/08/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Other
• Device Catalogue Number: 59006488
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/14/2021
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 11/12/2021
• Was Device Evaluated by Manufacturer?: Yes
• 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