MAUDE Adverse Event Report: SISTEMAS MEDICOS ALARIS S.A DE C.V. BD MAXZERO MINIBORE PRESSURE RATED EXTENSION SET; INTRAVASCULAR ADMINISTRATION SET

Catalog Number	MZ5302
Medical Device Problem Code	Obstruction of Flow (2423)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/01/2026
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that the bd maxzero minibore pressure rated extension set was occluded.The following information was provided by the initial reporter: we have come across some defective j loops that either dont flush dont thread or leak.I have the lot number bd maxzero lot 26025473 additional information received from the customer: can you please provide an exact date of events in format dd-mmm-yyyy? (b)(6) 2026, (b)(6) 2026, multiple others at each of my sites but i don't have exact dates total number of occurrences of each event? 1 did the issue happen during patient use? if yes, was there any injury? if so, please describe and include any medical treatment needed as a result? (b)(6) 2026- cap came off of j loop and patient had blood loss.Did not require medical treatment.(b)(6) 2026- prior to patient care, j loop would not flush.I have this j loop if you would like it.Other instances report leaking from the connector.
Additional Manufacturer Narrative
Device evaluation: no product or photo was returned by the customer.The customer complaint of flow issues - fluid blockage and connection issues could not be verified due to the product not being returned for failure investigation.A device history record review for material# mz5302 and lot# 26025473 was performed.The search showed that a total of (b)(4) units in 1 lot number was built on 17feb2026.There were no quality notifications issued for the failure mode reported by the customer during the production build of this set.Due to no sample being received, an investigation could not be performed, and a root cause could not be determined.This incident has been added to our database of reported incidents.Our business team regularly reviews the collected data for identification of emerging trends.Your assistance in this matter has been helpful in trend identification and supporting our commitment to continuous quality improvement.

• Brand Name: BD MAXZERO MINIBORE PRESSURE RATED EXTENSION SET
• Common Device Name: INTRAVASCULAR ADMINISTRATION SET
• Manufacturer (Section D): SISTEMAS MEDICOS ALARIS S.A DE C.V.; parque sur, el realito; blvd. 2000; tijuana 22250 ; MX 22250
• Manufacturer (Section G): SISTEMAS MEDICOS ALARIS S.A DE C.V.; parque sur, el realito; blvd. 2000; tijuana 22250 ; MX 22250
• Manufacturer Contact: helen cox (mdr) ; 75 north fairway drive; vernon hills, IL 60061 ; 8473935694
• MDR Report Key: 25263186
• Report Number: 9616066-2026-01369
• Device Sequence Number: 9186067
• Product Code: FPA
• UDI-Device Identifier: 10885403230554
• UDI-Public: (01)10885403230554(11)260217(17)290216(10)26025473
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K140831
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 05/11/2026

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: MZ5302
• Device Lot Number: 26025473
• 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: 05/04/2026
• Initial Report FDA Received Date: 05/22/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 02/17/2026
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown