MAUDE Adverse Event Report: EMBECTA MEDICAL DEVICES (SUZHOU) CO., LTD., CHINA PN RELION 31G X 6MM 3B TW 50CT; Needle, hypodermic, single lumen

Model Number	320617
Medical Device Problem Code	Failure to Deliver (2338)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
Lot: 3126871, (two boxes with same lot).Catalog: 6mmx31 pen needles,(box was discarded).Date of event: unknown.Samples: no.Reported pen needle clog with two boxes.Stated, over 10 pen needles affected from each box.Stated, no insulin flow when taking injections.Stated, he does not test his pen needles before taking injections.Replacement only.Cl.
Additional Manufacturer Narrative
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.

• Brand Name: PN RELION 31G X 6MM 3B TW 50CT
• Common Device Name: Needle, hypodermic, single lumen
• Manufacturer (Section D): EMBECTA MEDICAL DEVICES (SUZHOU) CO., LTD., CHINA; CH
• Manufacturer Contact: avital merl ; 300 kimball dr.; parsippany, NJ 07054
• MDR Report Key: 20471235
• Report Number: 3027605735-2024-00081
• Device Sequence Number: 15321457
• Product Code: FMI
• UDI-Device Identifier: 00681131386807
• UDI-Public: 00681131386807
• Combination Product (Y/N): Y
• Initial Reporter State: TN
• Initial Reporter Country: US
• PMA/510(K) Number: K213478
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 10/17/2024

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 Model Number: 320617
• Device Lot Number: 3126871
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/23/2024
• Initial Report FDA Received Date: 10/17/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 06/01/2023
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Male
• Patient Ethnicity: Non Hispanic
• Patient Race: White