MAUDE Adverse Event Report: BECTON DICKINSON IND. CIRURGICAS LTDA BD LUER-LOCK¿ SAFETY SYRINGE; PISTON SYRINGE

Catalog Number 307865

Device Problem Loose or Intermittent Connection (1371)

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

Event Date 09/02/2022

Event Type  malfunction  

Manufacturer Narrative

A device evaluation is anticipated but has not yet begun.Upon completion of the investigation, a supplemental report will be filed.

Event Description

It was reported that the needle pulled loose from the bd luer-lock¿ safety syringe hub after aspirating medication.The following information was provided by the initial reporter, translated from portuguese: "the nursing technician aspirated the immunobiological agent using the correct technique, and before applying it, noticed that the needle had come loose from the base (03 ml syringe/ 0.55x 20mm needle).Batch: 0195152 there was no harm to the patient".

Manufacturer Narrative

H6: investigation summary since no samples displaying the condition reported are available for examination, we were unable to fully investigate this incident, therefore a root cause could not be determined.A device history record review showed no rejected inspections or quality issues during the production of the provided lot number that could have contributed to the reported defect.H3 other text : see h10.

Event Description

It was reported that the needle pulled loose from the bd luer-lock¿ safety syringe hub after aspirating medication.The following information was provided by the initial reporter, translated from portuguese: "the nursing technician aspirated the immunobiological agent using the correct technique, and before applying it, noticed that the needle had come loose from the base (03 ml syringe/ 0.55x 20mm needle).Batch: 0195152 there was no harm to the patient".

• Brand Name: BD LUER-LOCK¿ SAFETY SYRINGE
• Type of Device: PISTON SYRINGE
• Manufacturer (Section D): BECTON DICKINSON IND. CIRURGICAS LTDA; 550 rua cyro correia pereira; curitiba
• Manufacturer (Section G): BECTON DICKINSON IND. CIRURGICAS LTDA; 550 rua cyro correia pereira; curitiba
• Manufacturer Contact: phillip emmert ; 9450 south state street; sandy, UT 84070 ; 8015296192
• MDR Report Key: 16376927
• MDR Text Key: 309654623
• Report Number: 3003916417-2023-00026
• Device Sequence Number: 1
• Product Code: FMF
• Combination Product (y/n): N
• Reporter Country Code: BR
• PMA/PMN Number: NA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Foreign
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date: 02/24/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/15/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: 307865
• Device Lot Number: 0195152
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 02/24/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 07/13/2020
• 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