MAUDE Adverse Event Report: BECTON, DICKINSON & CO., (BD) BD VACUTAINER® ULTRATOUCH¿ PUSH BUTTON BLOOD COLLECTION SET WITH PAH; INTRAVASCULAR ADMINISTRATION SET

Catalog Number	368688
Medical Device Problem Codes	Backflow (1064); Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/17/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
A device evaluation and/or device history review is anticipated but is not complete.Upon completion, a supplemental report will be filed.D.2b medical device type: one additional code applies; jka.
Event or Problem Description
It was reported that while using bd vacutainer® ultratouch¿ push button blood collection set with pah, the customer noticed the blood was flowing slowly into the tube, then began backflowing into the vein, and when the needle was retracted, the blood leaked all over the patient and the bed.Recollection was performed.
Additional Manufacturer Narrative
Investigation summary bd received one photo for investigation, which shows a device with blood leakage in the rear sample.Additionally, 30 retained samples underwent functional tests to assess the device's functionality.All retained samples passed the tests, exhibiting no signs of damage, leakage, or insufficient blood flow during use.Furthermore, all 30 retained samples were tested for proper activation and passed, with no evidence of leakage or retraction defects.Based on a review of the device history record for the incident lot, all product specifications and requirements for lot release were met.This complaint has been confirmed for the indicated failure modes: insufficient blood flow and leakage.No definitive root cause could be established for the reported defect.Complaints received for this device and reported condition will continue to be tracked and trended.Information will be captured on trend reports and monitored.Our business team regularly reviews the collected data for the identification of emerging trends.
Event or Problem Description
It was reported that while using bd vacutainer® ultratouch¿ push button blood collection set with pah, the customer noticed the blood was flowing slowly into the tube, then began backflowing into the vein, and when the needle was retracted, the blood leaked all over the patient and the bed.Recollection was performed.

• Brand Name: BD VACUTAINER® ULTRATOUCH¿ PUSH BUTTON BLOOD COLLECTION SET WITH PAH
• Common Device Name: INTRAVASCULAR ADMINISTRATION SET
• Manufacturer (Section D): BECTON, DICKINSON & CO., (BD); 1575 airport road; sumter SC 29153
• Manufacturer (Section G): BECTON, DICKINSON & CO., (BD); 1575 airport road; sumter SC 29153
• Manufacturer Contact: matt j. connor ; 7 loveton circle; sparks, MD 21152 ; 4103164000
• MDR Report Key: 22021937
• Report Number: 1024879-2025-00661
• Device Sequence Number: 9530713
• Product Code: FPA
• UDI-Device Identifier: 30382903686880
• UDI-Public: (01)30382903686880(11)241118(17)261130(10)4323607
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K212724
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/03/2025

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: Other
• Device Catalogue Number: 368688
• Device Lot Number: 4323607
• 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: 04/17/2025
• Supplement Date Received by Manufacturer: 11/03/2025
• Initial Report FDA Received Date: 05/14/2025
• Supplement Report FDA Received Date: 11/17/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 11/18/2024
• 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