MAUDE Adverse Event Report: CARDINAL HEALTH SAFETY NEEDLE 23 X 1; NEEDLE, HYPODERMIC, SINGLE LUMEN

Model Number	8881850310
Medical Device Problem Code	Air/Gas in Device (4062)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
Customer reports: air bubbles are forming in the needles.
Additional Manufacturer Narrative
An investigation is currently underway.Upon completion, the results will be forwarded.
Additional Manufacturer Narrative
The device history record (dhr) review indicates that that all acceptance criteria inspections per established sampling levels were within acceptable limits.There were no samples submitted with this complaint.The reported condition could not be confirmed.Without a sample we are unable to perform a thorough follow up investigation to include a functional and visual evaluation or to determine the root cause(s) of the reported condition or implement any corrective action(s).If a sample should be returned in the future, this complaint will be reopened, and the investigation updated to reflect our findings.Unfortunately, without a sample we are unable to confirm the reported condition.Since this complaint will be considered unconfirmed, no corrective or preventive actions will be taken at this time this information will be utilized for trending purposes to determine the need for corrective actions.

• Brand Name: SAFETY NEEDLE 23 X 1
• Common Device Name: NEEDLE, HYPODERMIC, SINGLE LUMEN
• Manufacturer (Section D): CARDINAL HEALTH; 777 west street; mansfield MA 32724
• Manufacturer (Section G): CARDINAL HEALTH; 2010 east international speedw; deland FL 32724
• Manufacturer Contact: jill saraiva ; 777 west street; mansfield, MA 02048 ; 5086183640
• MDR Report Key: 15743576
• Report Number: 1017768-2022-01035
• Device Sequence Number: 17558072
• Product Code: FMI
• UDI-Device Identifier: 10884521000544
• UDI-Public: 10884521000544
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility,Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 01/12/2023

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
• Device Model Number: 8881850310
• Device Catalogue Number: 8881850310
• Device Lot Number: 203176
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/04/2022
• Supplement Date Received by Manufacturer: 11/04/2022
• Initial Report FDA Received Date: 11/07/2022
• Supplement Report FDA Received Date: 01/12/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown