MAUDE Adverse Event Report: BECTON DICKINSON BD SHARPS COLL SIDE ENTRY 5.4QT PEARL 20/PK; HYPODERMIC SINGLE LUMEN NEEDLE

Model Number	305444
Medical Device Problem Code	Component Missing (2306)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/16/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The manufacturing location for this product is flextronics.This site is an oem manufacturing site.Therefore, bd corporate headquarters in franklin lakes, nj has been listed and the franklin lakes 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.
Event or Problem Description
It was reported while using bd sharps coll side entry 5.4qt pearl 20/pk the lid was missing.There was no report of patient impact.The following information was provided by the initial reporter: mds-bd1 verbatim: we were notified that item bf305444's lid is missing.
Additional Manufacturer Narrative
H6.Investigation summary: no product or photo was returned by the customer.It was reported by the customer that they the customer is missing 5/6 lids from their order back in march could not be verified due to the product not being returned for failure investigation.Based on the information provided, the device history record review process was unable to be performed since there was no lot number provided.A review of the ncmr¿s was performed; the result showed no issues reported for missing lids for the same part number throughout the last twelve months.
Event or Problem Description
It was reported while using bd sharps coll side entry 5.4qt pearl 20/pk the lid was missing.There was no report of patient impact.The following information was provided by the initial reporter: mds-bd1 verbatim: we were notified that item bf305444's lid is missing.

• Brand Name: BD SHARPS COLL SIDE ENTRY 5.4QT PEARL 20/PK
• 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: 15557523
• Report Number: 2243072-2022-01740
• Device Sequence Number: 15222254
• Product Code: FMI
• UDI-Device Identifier: 00382903054442
• UDI-Public: 00382903054442
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• 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,Distributor
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 10/27/2022

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: 305444
• Device Catalogue Number: 305444
• Device Lot Number: UNKNOWN
• 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: 09/16/2022
• Supplement Date Received by Manufacturer: 10/27/2022
• Initial Report FDA Received Date: 10/06/2022
• Supplement Report FDA Received Date: 11/10/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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