MAUDE Adverse Event Report: BECTON DICKINSON BD NEXIVA 20GA 1.25IN HF Y; INTRAVASCULAR CATHETER

Catalog Number	383537
Medical Device Problem Code	Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/27/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that bd nexiva 20ga 1.25in hf y leaked.The septum of the bd nexiva dp 20g 383537, through which the safety cannula is removed, leaks during subsequent use.When did the incident occur? during use.Detailed incident description: the septum of the bd nexiva dp 20g 383537, through which the safety cannula is removed, leaks during subsequent use.Both blood and infusion solution come out.
Additional Manufacturer Narrative
H.3.If a device evaluation and/or device history review is completed, a supplemental report will be filed.
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
No additional information.
Additional Manufacturer Narrative
Our quality engineer inspected the 3 representative samples submitted for evaluation.The reported issue of leakage was not confirmed upon inspection of the samples.Analysis of the samples showed no damages or defects.Samples were subject to a flashback and catheter air-water leak test, and no abnormalities were observed.Samples passed testing.A review of our risk management documentation was performed and indicates that the potential risk of the reported event was assessed appropriately.Production records were reviewed, and this batch meets our manufacturing specification requirements.A root cause could not be determined as the defect was not replicated.

• Brand Name: BD NEXIVA 20GA 1.25IN HF Y
• Common Device Name: INTRAVASCULAR CATHETER
• Manufacturer (Section D): BECTON DICKINSON; 1 becton drive; franklin lakes NJ 07417
• Manufacturer (Section G): BECTON DICKINSON MEDICAL (SINGAPORE); 30 tuas avenue 2; suzhou industrial park; singapore 21502 1; CH 215021
• Manufacturer Contact: helen cox (mdr) ; 75 north fairway drive; vernon hills, IL 60061 ; 8473935694
• MDR Report Key: 21183522
• Report Number: 2243072-2024-01320
• Device Sequence Number: 8630351
• Product Code: FOZ
• UDI-Device Identifier: 00382903835379
• UDI-Public: (01)00382903835379(11)240501(17)270430(10)4118040
• Combination Product (Y/N): N
• Initial Reporter Country: AU
• PMA/510(K) Number: K183399
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 04/10/2025

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: 383537
• Device Lot Number: 4118040
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/27/2024
• Supplement Date Received by Manufacturer: 03/06/2025; 04/10/2025
• Initial Report FDA Received Date: 01/17/2025
• Supplement Report FDA Received Date: 03/10/2025; 04/11/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/01/2024
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown