MAUDE Adverse Event Report: BECTON DICKINSON BD NEEDLE ECLIPSE 21X1 RB TW; HYPODERMIC SINGLE LUMEN NEEDLE

Catalog Number	305764
Medical Device Problem Code	Material Protrusion/Extrusion (2979)
Health Effect - Clinical Code	Needle Stick/Puncture (2462)
Date of Event	10/15/2024
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
It was reported that bd needle eclipse 21x1 rb tw safety shield broke off.It was reported by customer that the phlebotomist was using a 21gx1 eclipse needle on a hub to draw blood.When she went to safety the device on her hand, the safety came off causing an accidental needle stick in the phlebotomist.Verbatim: rcc received a complaint via community.Pir attached.Our phlebotomist was using a 21gx1 eclipse needle on a hub to draw blood.When she went to safety the device on her hand, the safety came off causing an accidental needle stick in the phlebotomist.
Additional Manufacturer Narrative
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 numbers 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
Material #:305764, batch#:4055237.It was reported by customer that the phlebotomist was using a 21gx1 eclipse needle on a hub to draw blood.When she went to safety the device on her hand, the safety came off causing an accidental needle stick in the phlebotomist.Verbatim: rcc received a complaint via community.Pir attached.Our phlebotomist was using a 21gx1 eclipse needle on a hub to draw blood.When she went to safety the device on her hand, the safety came off causing an accidental needle stick in the phlebotomist.

• Brand Name: BD NEEDLE ECLIPSE 21X1 RB TW
• Common Device Name: HYPODERMIC SINGLE LUMEN NEEDLE
• Manufacturer (Section D): BECTON DICKINSON; 1 becton drive; franklin lakes NJ 07417
• Manufacturer (Section G): BECTON DICKINSON MEDICAL (SINGAPORE); 30 tuas avenue 2; singapore NJ 07417
• Manufacturer Contact: helen cox (mdr) ; 75 north fairway drive; vernon hills, IL 60061 ; 8473935694
• MDR Report Key: 20637860
• Report Number: 2243072-2024-01107
• Device Sequence Number: 7404348
• Product Code: FMI
• UDI-Device Identifier: 00382903057641
• UDI-Public: (01)00382903057641(11)240303(17)290228(10)4055237
• Combination Product (Y/N): N
• Initial Reporter State: CO
• Initial Reporter Country: US
• PMA/510(K) Number: K010188
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/02/2024

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: Health Professional
• Device Catalogue Number: 305764
• Device Lot Number: 4055237
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/15/2024
• Supplement Date Received by Manufacturer: 12/02/2024
• Initial Report FDA Received Date: 11/08/2024
• Supplement Report FDA Received Date: 12/02/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 03/03/2024
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown