MAUDE Adverse Event Report: BECTON DICKINSON BD SHARPS COLLECTOR 5.4QT RED; HYPODERMIC SINGLE LUMEN NEEDLE

Model Number	305517
Medical Device Problem Code	Defective Component (2292)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/22/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Oem manufacture: 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.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.
Event or Problem Description
It was reported that bd sharps collector 5.4qt red experienced a case of lid damage, and a case of device damage while still considered operable.The following information was provided by the initial reporter: the hcp noticed that the one side of the rotation axis of the lid and the bottom surface of the base were damaged.
Additional Manufacturer Narrative
H.6.Investigation: no photos or samples were received in order to identify the root cause for the issue.Additional attempt to get more information were made, however, the customer confirmed that no additional information was available.According to the dhr review process, the result showed there were no issues reported like lid broken ¿ damaged or base broken ¿ damaged during the manufacturing process of the lot number reported (1052914) under this customer complaint.Also, a review of the ncmr¿s was performed; the result showed there were no issues reported like lids broken-damaged or base broken-damaged for the same part number throughout the last twelve months.The complaint could not be confirmed and the root cause is undetermined.
Event or Problem Description
It was reported that bd sharps collector 5.4qt red experienced a case of lid damage, and a case of device damage while still considered operable.The following information was provided by the initial reporter: the hcp noticed that the one side of the rotation axis of the lid and the bottom surface of the base were damaged.

• Brand Name: BD SHARPS COLLECTOR 5.4QT RED
• Common Device Name: HYPODERMIC SINGLE LUMEN NEEDLE
• 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: phillip emmert ; 9450 south state street; sandy, UT 84070 ; 8015296192
• MDR Report Key: 13261757
• Report Number: 2243072-2021-03129
• Device Sequence Number: 20023805
• Product Code: FMI
• UDI-Device Identifier: 00382903055173
• UDI-Public: 00382903055173
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K943141
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Foreign,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 04/21/2022

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
• Operator of Device: Other
• Device Model Number: 305517
• Device Catalogue Number: 305517
• Device Lot Number: 1052914
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/22/2021
• Supplement Date Received by Manufacturer: 04/21/2022
• Initial Report FDA Received Date: 01/14/2022
• Supplement Report FDA Received Date: 04/29/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/08/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown