MAUDE Adverse Event Report: BECTON DICKINSON INFUSION THERAPY SYSTEMS INC. BD INSYTE¿ AUTOGUARD¿ BC PRO SHIELDED IV CATHETER; INTRAVASCULAR CATHETER

Model Number	392523
Medical Device Problem Code	Retraction Problem (1536)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/11/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
B.3.Date of event: unknown.The date received by manufacturer has been used for this field.H.3.A device evaluation is anticipated but has not yet begun.Upon completion of the investigation, a supplemental report will be filed.
Event or Problem Description
It was reported that the safety mechanism on the bd insyte¿ autoguard¿ bc pro shielded iv catheter was difficult to activate, making it difficult to remove the needle after placing the catheter.The following information was provided by the initial reporter: "reported issue: occurred during patient use but per customer, "patient wasn't injured the catheter sticks which causes issues with iv not being properly placed.Injuries or adverse event: no.Can you please provide additional details in regards to the issue? it almost felt like the needles were blunt and they were "tough" to advance catheters once inserted.Was the tip adhesion ¿broken¿ properly? yes.Was there an issue with the retraction? yes it was hard to push the button on some of them.Was there any patient impact or patient involvement? yes, caused multiple iv sticks on patients because catheters would not advance or they were so hard to advance caused to blow the vein.".
Additional Manufacturer Narrative
H6: investigation summary: there was no sample or photo available to bd for evaluation.Therefore, bd was unable to perform a thorough investigation to verify the reported issue.Since, an investigation could not be performed bd was unable to determine a possible root cause.A review of the device history record was performed and no quality issues were found during production.
Event or Problem Description
It was reported that the safety mechanism on the bd insyte¿ autoguard¿ bc pro shielded iv catheter was difficult to activate, making it difficult to remove the needle after placing the catheter.The following information was provided by the initial reporter: "reported issue: occurred during patient use but per customer, "patient wasn't injured the catheter sticks which causes issues with iv not being properly placed.Injuries or adverse event: no.Can you please provide additional details in regards to the issue? it almost felt like the needles were blunt and they were "tough" to advance catheters once inserted.Was the tip adhesion ¿broken¿ properly? yes.Was there an issue with the retraction? yes it was hard to push the button on some of them.Was there any patient impact or patient involvement? yes, caused multiple iv sticks on patients because catheters would not advance or they were so hard to advance caused to blow the vein.".

• Brand Name: BD INSYTE¿ AUTOGUARD¿ BC PRO SHIELDED IV CATHETER
• Common Device Name: INTRAVASCULAR CATHETER
• Manufacturer (Section D): BECTON DICKINSON INFUSION THERAPY SYSTEMS INC.; 9450 south state street; sandy UT 84070
• Manufacturer (Section G): BECTON DICKINSON INFUSION THERAPY SYSTEMS INC.; 9450 south state street; sandy UT 84070
• Manufacturer Contact: phillip emmert ; 9450 south state street; sandy, UT 84070 ; 8448235433
• MDR Report Key: 16912787
• Report Number: 1710034-2023-00500
• Device Sequence Number: 11325791
• Product Code: FOZ
• UDI-Device Identifier: 00382903925230
• UDI-Public: 00382903925230
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K201075
• 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): 05/31/2023

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 Expiration Date: 10/31/2025
• Device Model Number: 392523
• Device Catalogue Number: 392523
• Device Lot Number: 2308068
• 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: 04/17/2023
• Supplement Date Received by Manufacturer: 05/31/2023
• Initial Report FDA Received Date: 05/11/2023
• Supplement Report FDA Received Date: 06/13/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/10/2022
• 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