MAUDE Adverse Event Report: BECTON DICKINSON MEDICAL (SINGAPORE) BD ECLIPSE¿ NEEDLE 25 G X 1 1/2 IN. SINGLE USE STERILE; HYPODERMIC SINGLE LUMEN NEEDLE

Model Number	305767
Medical Device Problem Code	Complete Blockage (1094)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/31/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
H.3.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 eclipse¿ needle 25 g x 1 1/2 in.Single use sterile the needle was clogged.There was no report of patient impact.The following information was provided by the initial reporter: incident date: on (b)(6) 2023.Hospital complaint reference#: details of complaint (reported issue): the needles of this batch appear to be jamming.Please note: this complaint is being brought forward by the products end user.If you have any specific questions regarding this complaint please direct them to the below contact.Complaint noticed: during / after use.Problem frequency: 1st time.
Additional Manufacturer Narrative
H6: investigation summary no photos or samples were received by our quality team for evaluation therefore the failure mode could not be verified.A review of the internal manufacturing device records and raw material history files for the reported lot number was performed and no recorded quality problems or rejections to this incident were found.Based on the quality team's investigation, the root cause of this incident cannot be determined.
Event or Problem Description
It was reported while using bd eclipse¿ needle 25 g x 1 1/2 in.Single use sterile the needle was clogged.There was no report of patient impact.The following information was provided by the initial reporter: incident date: (b)(6) 2023 hospital complaint reference #: details of complaint (reported issue): the needles of this batch appear to be jamming.** please note: this complaint is being brought forward by the products end user.If you have any specific questions regarding this complaint please direct them to the below contact.** complaint noticed: during / after use problem frequency: 1st time.

• Brand Name: BD ECLIPSE¿ NEEDLE 25 G X 1 1/2 IN. SINGLE USE STERILE
• Common Device Name: HYPODERMIC SINGLE LUMEN NEEDLE
• Manufacturer (Section D): BECTON DICKINSON MEDICAL (SINGAPORE); 30 tuas avenue 2; singapore
• Manufacturer (Section G): BECTON DICKINSON MEDICAL (SINGAPORE); 30 tuas avenue 2; singapore
• Manufacturer Contact: phillip emmert ; 9450 south state street; sandy, UT 84070 ; 8448235433
• MDR Report Key: 16782277
• Report Number: 8041187-2023-00169
• Device Sequence Number: 12182405
• Product Code: FMI
• UDI-Device Identifier: 30382903057673
• UDI-Public: (01)30382903057673
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: CA
• PMA/510(K) Number: K010188
• 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): 04/28/2023

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
• Operator of Device: Other
• Device Model Number: 305767
• Device Catalogue Number: 305767
• Device Lot Number: 2060561
• 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: 03/31/2023
• Supplement Date Received by Manufacturer: 04/28/2023
• Initial Report FDA Received Date: 04/20/2023
• Supplement Report FDA Received Date: 05/16/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/01/2022
• 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