MAUDE Adverse Event Report: BECTON, DICKINSON & CO. (SPARKS) BD BACTEC¿ FX, INSTRUMENT BOTTOM, PACKAGED; SYSTEM, BLOOD CULTURING

Model Number	441386
Medical Device Problem Code	False Positive Result (1227)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/31/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Medical device expiration date: na.A device evaluation and/or device history review is anticipated, but is not complete.Upon completion, a supplemental report will be filed.
Event or Problem Description
It has been reported that the bd bactec¿ fx, instrument bottom, packaged has been found producing a false positive result.There was no report of confirmatory testing.There was no report of patient impact.The following has been provided by the initial reporter: customer is reporting 4-6 anaerobic 442021 bottles that are false positive.
Event or Problem Description
It has been reported that the bd bactec¿ fx, instrument bottom, packaged has been found producing a false positive result.There was no report of confirmatory testing.There was no report of patient impact.The following has been provided by the initial reporter: customer is reporting 4-6 anaerobic 442021 bottles that are false positive.
Additional Manufacturer Narrative
H.6 investigation summary: a complaint of "4 - 6 442021 bottles false positive detected" was received against instrument bottom bactec fx packaged material number: 441386, serial number: (b)(6).Instrument was found to be functional, and the customer started using the instrument for regular operation.This is an unconfirmed complaint, and the root cause was unable to be determined.Device history record review for the instrument (b)(6), is not required for this complaint as this complaint does not allege an early life failure or failure at installation and the configuration has changed since release from manufacturing due to service repairs/pms.Service history review revealed no previous complaint for this issue.No parts were replaced as part of this complaint, and therefore no samples were returned, and no returned material investigation could occur.Complaints for "results" are under statistical control for the month of april 2022.The upper control limit was not breached.Quality will continue to monitor the ¿results".No new trends have been identified.Review of risk management documentation indicates that the potential risk of the reported failure mode was assessed as severity s1 (user inconvenience) via document baltrmbactecinstraph revision 15 id 1.2c.

• Brand Name: BD BACTEC¿ FX, INSTRUMENT BOTTOM, PACKAGED
• Common Device Name: SYSTEM, BLOOD CULTURING
• Manufacturer (Section D): BECTON, DICKINSON & CO. (SPARKS); 7 loveton circle; sparks MD 21152
• Manufacturer (Section G): BECTON, DICKINSON & CO. (SPARKS); 7 loveton circle; sparks MD 21152
• Manufacturer Contact: phillip emmert ; 9450 south state street; sandy, UT 84070 ; 8015296192
• MDR Report Key: 14178011
• Report Number: 1119779-2022-00588
• Device Sequence Number: 5783337
• Product Code: MDB
• UDI-Device Identifier: 00382904413866
• UDI-Public: 00382904413866
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• PMA/510(K) Number: K915796
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/03/2022

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: 441386
• Device Catalogue Number: 441386
• 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: 03/31/2022
• Supplement Date Received by Manufacturer: 11/03/2022
• Initial Report FDA Received Date: 04/21/2022
• Supplement Report FDA Received Date: 11/14/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 01/13/2020
• Is the Device Labeled for Single Use? (Y/N): No
• 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