MAUDE Adverse Event Report: BECTON DICKINSON, S.A. BD PHASEAL; INJECTOR LOCKING N40-O

Catalog Number	515056
Medical Device Problem Code	Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/10/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Initial mdr, if a device evaluation and/or device history review is completed, a supplemental report will be filed.
Event or Problem Description
Event details: i was administering azacitidine sc to a patient.Upon administering the first syringe, a few drops of the azacitidine leaked out of the end of the cstd closest to the patient (where the male and female piece connect).A few drops of azacitidine spilled onto the patient, the rest of the dose was administered.A click was heard when i was connecting all male and female cstd pieces and they looked secure upon administration.The spill was cleansed with gauze and alcohol swabs and the patient was made aware to double wash his pants immediately upon returning home.".Complaint noticed: during / after use.Problem frequency: 1st time.Patient injury: no.Qty affected: 1 each.

• Brand Name: BD PHASEAL
• Common Device Name: INJECTOR LOCKING N40-O
• Manufacturer (Section D): BECTON DICKINSON, S.A.; camino de valdeolivia; s/n; san agustin de guadalix
• Manufacturer (Section G): BECTON DICKINSON, S.A.; camino de valdeolivia; s/n; san agustin de guadalix
• Manufacturer Contact: helen cox (mdr) ; 75 north fairway drive; vernon hills, IL 60061 ; 8473935694
• MDR Report Key: 23694423
• Report Number: 3003152976-2025-00662
• Device Sequence Number: 18410015
• Product Code: ONB
• UDI-Device Identifier: 00382905150562
• UDI-Public: (01)00382905150562(11)241118(17)270430(10)2411304
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K201099
• 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
• Report Date (Section B): 11/20/2025

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: 515056
• Device Lot Number: 2411304
• 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: 11/17/2025
• Initial Report FDA Received Date: 12/02/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 11/18/2024
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown