MAUDE Adverse Event Report: SOL-MILLENNIUM MEDICAL INC DROPLET SYRINGE; HTL/DROPLET 0.5ML INSULIN SYRINGE 30G * 12.5MM

Model Number	6008
Medical Device Problem Code	Suction Failure (4039)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/17/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
There is no evidence of quality issues associated with this complaint based on the return sample and archive sample analysis.Based on the determined risk priority number, the residual risk related to the complaint is considered acceptable.Sol millennium continues to monitor this kind of issue.Additional assessment will be taken if a significant pattern emerges.Unconfirmed.This report was initially submitted on 07/26/2024.Due to issues with displaying the initial submission, this submission contains both initial and supplemental information.
Event or Problem Description
Customer stated she is having problems with her droplet insulin syringes drawing insulin for her injections.She said the insulin will not go into the needle, as if there is a hole causing the loss of suction.Customer said she has thrown several syringes away because of the problem.Customer was able to achieve the correct dose of insulin using a new syringe.Customer did not suffer any health consequences due to the problem.Customer said she followed the instructions for use included in the box.
Additional Manufacturer Narrative
This report when initially submitted encountered an internal issue potentially related to database connectivity.This issue was identified while implementing capa-57 which was opened following an fda inspection.This supplemental mdr is being submitted to correct brand name provided in the initial mdr [3014312726-2024-00282].The previously reported was incorrect.The correct brand name is droplet syringe.

• Brand Name: DROPLET SYRINGE
• Common Device Name: HTL/DROPLET 0.5ML INSULIN SYRINGE 30G * 12.5MM
• Manufacturer (Section D): SOL-MILLENNIUM MEDICAL INC; 311 s. wacker dr.,; suite 4100; chicago IL 60606
• Manufacturer (Section G): ZHEJIANG KINDLY MEDICAL DEVICES CO., LTD.; 758 binhai 5th avenue, binhai; industrial park, longwan,; wenzhou city,, zhejiang province 32502 5; CH 325025
• Manufacturer Contact: jarryd franklin ; 311 s. wacker dr.,; suite 4100; chicago, IL 60606
• MDR Report Key: 22035699
• Report Number: 3014312726-2024-00282
• Device Sequence Number: 8733635
• Product Code: FMF
• UDI-Device Identifier: 05907996095650
• UDI-Public: (01)05907996095650
• Combination Product (Y/N): N
• Initial Reporter Country: PL
• PMA/510(K) Number: K153537
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Consumer,Health Professional,Distributor
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 08/12/2025

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: Lay User/Patient
• Device Model Number: 6008
• Device Lot Number: 02205034
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/05/2024
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/22/2024
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 05/16/2025
• Supplement Report FDA Received Date: 08/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 07/08/2022
• 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: Female