MAUDE Adverse Event Report: BD MEDICAL - DIABETES CARE BD ULTRA-FINE¿ INSULIN SYRINGE; PISTON SYRINGE

Catalog Number	324910
Medical Device Problem Code	Detachment of Device or Device Component (2907)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/06/2023
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.6.Investigation summary: no samples (including photos) were returned therefore the complaint could not be confirmed and the root cause is undetermined.This is the 1st complaint for the reported lot number.A review of the manufacturing records was performed, and no non-conformances were raised in association with this type of event for this lot.Complaints received for this device and reported condition will continue to be tracked and trended.If samples are received in the future the complaint will be reopened for further investigation.Based on the above, no additional investigation and no corrective/preventative action (capa) or situational analysis (sa) is required at this time.
Event or Problem Description
It was reported while using the bd ultra-fine¿ insulin syringe the hub separated from the device.Report 2 of 2.The following was received from the initial reporter: pet owner reported when injecting her cat on (b)(6) 2023 the needle broke off in site.11/06/2023 - today the needle was removed by the vet without sedation.Pet owner reported on 11/06/2023 when removed the needle shield from syringe, the needle assembly stayed in the shield.
Additional Manufacturer Narrative
The following fields have been updated due to additional information: correction: after further evaluation of the complaint, it has been determined that the previously submitted report 9369793 was sent in error.After review it was confirmed that this product used on an animal is not cleared for vet use.Mfr#: 1920898-2023-00810is void as a result.H3 other text : see h.10.
Event or Problem Description
It was reported while using the bd ultra-fine¿ insulin syringe the hub separated from the device.Report 2 of 2.The following was received from the initial reporter: pet owner reported when injecting her cat on (b)(6) 2023 the needle broke off in site.(b)(6) 2023 - today the needle was removed by the vet without sedation.Pet owner reported on (b)(6) 2023 when removed the needle shield from syringe, the needle assembly stayed in the shield.

• Brand Name: BD ULTRA-FINE¿ INSULIN SYRINGE
• Common Device Name: PISTON SYRINGE
• Manufacturer (Section D): BD MEDICAL - DIABETES CARE; 1329 west highway 6; holdrege NE 68949
• Manufacturer (Section G): BD MEDICAL - DIABETES CARE; 1329 west highway 6; holdrege NE 68949
• Manufacturer Contact: jennifer suh ; 5859 farinon drive; san antonio, TX 78249 ; 8448235433
• MDR Report Key: 18301964
• Report Number: 1920898-2023-00810
• Device Sequence Number: 16938042
• Product Code: FMF
• UDI-Device Identifier: 00382903249107
• UDI-Public: (01)00382903249107
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K212499
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Consumer
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/18/2023

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: Lay User/Patient
• Device Catalogue Number: 324910
• Device Lot Number: 6
• 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: 11/06/2023
• Supplement Date Received by Manufacturer: 11/06/2023
• Initial Report FDA Received Date: 12/11/2023
• Supplement Report FDA Received Date: 12/18/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/18/2016
• 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