MAUDE Adverse Event Report: BECTON DICKINSON MEDICAL SYSTEMS 3ML BD POSIFLUSH¿ HEPARIN LOCK FLUSH SYRINGE, IN 10ML SYRINGE, 10 USP UNITS/ML; PREFILLED HEPARIN FLUSH SYRINGE

Catalog Number 306521

Device Problem Loose or Intermittent Connection (1371)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 04/13/2018

Event Type  Injury  

Manufacturer Narrative

Date of event: unknown.The date received by manufacturer has been used for this field.Multiple potential lot numbers were provided for this incident.The information for each lot number is as follows: medical device lot #: 719291n, medical device expiration date: 1/10/2019, device manufacture date: 7/17/2017.Medical device lot #: 726971n, medical device expiration date: 3/25/2019, device manufacture date: 9/29/2017.Medical device lot #: 726391n, medical device expiration date: 3/19/2019, device manufacture date: 9/26/2017.Medical device lot #: 726472n, medical device expiration date: 3/20/2019, device manufacture date: 9/26/2017.Medical device lot #: 718091n, medical device expiration date: 12/2/2018, device manufacture date: 7/8/2017.Medical device lot #: 721481n, medical device expiration date: 2/1/2019, device manufacture date: 8/8/2017.A device evaluation is anticipated, but has not yet begun.Upon completion of the investigation, a supplemental report will be filed.

Event Description

It was reported that infections associated with central lines and the use of a 3 ml bd posiflush¿ heparin lock flush syringe, in 10 ml syringe, 10 usp units/ml were being investigated by the fda.There was no evidence that the bd device is implicated but all sources and common products are being investigated.

Manufacturer Narrative

Type of report: the initial mdr was submitted as a 30-day report.Bd has changed our position on this incident and we are making a correction to report the mdr as a 5-day report.

Event Description

It was reported that infections associated with central lines and the use of a 3 ml bd posiflush heparin lock flush syringe, in 10 ml syringe, 10 usp units/ml were being investigated by the fda.There was no evidence that the bd device is implicated but all sources and common products are being investigated.

Manufacturer Narrative

Lot numbers 718091n, 719291n, 721481n, 726391n, 726472n, and 726971n for product code (b)(4) were provided for evaluation by our quality engineer team.Upon reviewing the production history for the provided lot numbers, no deviations or non-conformances were identified during the manufacturing process.A corrective and preventive action plan was initiated to further investigate and monitor this issue.One-hundred and twenty retained samples for each lot number provided were visually inspected and no abnormalities were observed in regards to the solution.Forty retained samples for each lot number provided were sent for sterility testing.The sterility testing confirmed that the samples exhibited no microbial growth after incubation.A direct causation between the reported infections and the bd franklin product has not been identified.The root cause analysis of the reported infection cases under (b)(4) has not identified a direct causation between the infections and the bd franklin product.

• Brand Name: 3ML BD POSIFLUSH¿ HEPARIN LOCK FLUSH SYRINGE, IN 10ML SYRINGE, 10 USP UNITS/ML
• Type of Device: PREFILLED HEPARIN FLUSH SYRINGE
• Manufacturer (Section D): BECTON DICKINSON MEDICAL SYSTEMS; 9630 south 54th street; franklin WI 53132
• MDR Report Key: 7467623
• MDR Text Key: 106701046
• Report Number: 2134319-2018-00005
• Device Sequence Number: 1
• Product Code: FOZ
• UDI-Device Identifier: 30382903065210
• UDI-Public: 30382903065210
• Combination Product (y/n): N
• PMA/PMN Number: K011967
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other
• Type of Report: Initial,Followup,Followup
• Report Date: 08/07/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/27/2018
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Other
• Device Catalogue Number: 306521
• Device Lot Number: SEE H.10.
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 04/13/2018
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other