MAUDE Adverse Event Report: BECTON DICKINSON MEDICAL SYSTEMS BD SYRINGE 3ML LL W/NDL 18X1-1/2 BLUNT FILL; PISTON SYRINGE

Catalog Number	305060
Medical Device Problem Code	Device Contamination with Chemical or Other Material (2944)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/26/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
H.3.If a device evaluation and/or device history review is completed, a supplemental report will be filed.
Event or Problem Description
Material #:305060, batch#:4088192.It was reported that the bd syringe 3ml ll w/ndl 18x1-1/2 blunt fill had foreign matter.The following information was provided by the initial reporter: verbatim: rcc received a complaint via email.Email(s) attached.Syringe18 g x 1 1 / 2 in bd; 3 ml bd luer-lok blunt.O&m complaint record number(s): (b)(4).O&m product number:0723305060, supplier product number:305060, supplier product description: syringe18 g x 1 1 / 2 in bd; 3 ml bd luer-lok blunt, supplier lot number(s):4088192, sample availability: y, dc# 30, o&m po# 3126341, sales# 1118211, credit or replacement request? no.Additional information provided: 1.Please provide the date of event.9-26-24.2.Please describe about the product issue even more briefly.A nurse took the cap off of a 3ml syringe with blunt needle and found a powdery substance.3.Please share the captured photo of the event if available.Attached.4.Please provide the address of the facility for us to ship the return label? (b)(6).
Additional Manufacturer Narrative
(b)(4) - supplemental mdr - foreign matter.Since no samples displaying the condition reported are available for examination, we were unable to fully investigate this incident.No root cause can be determined as no samples were received.Furthermore, 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.
Event or Problem Description
No additional information was provided.

• Brand Name: BD SYRINGE 3ML LL W/NDL 18X1-1/2 BLUNT FILL
• Common Device Name: PISTON SYRINGE
• Manufacturer (Section D): BECTON DICKINSON MEDICAL SYSTEMS; route 7 and grace way; canaan CT 06018
• Manufacturer (Section G): BECTON DICKINSON MEDICAL SYSTEMS; route 7 and grace way; canaan CT 06018
• Manufacturer Contact: helen cox (mdr) ; 75 north fairway drive; vernon hills, IL 60061 ; 8473935694
• MDR Report Key: 20559879
• Report Number: 1213809-2024-00768
• Device Sequence Number: 8996204
• Product Code: FMF
• UDI-Device Identifier: 30382903050605
• UDI-Public: (01)30382903050605(11)240328(17)290228(10)4088192
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: K110771
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Study
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 01/09/2025

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: Health Professional
• Device Catalogue Number: 305060
• Device Lot Number: 4088192
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/04/2024
• Supplement Date Received by Manufacturer: 01/09/2025
• Initial Report FDA Received Date: 10/29/2024
• Supplement Report FDA Received Date: 01/13/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 03/28/2024
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown