MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 EAR / ULCER SYRINGE (BLUE) 2 OZ. BULK / 250; EAR SYRINGE

Catalog Number	9035820
Medical Device Problem Code	Device Damaged Prior to Use (2284)
Health Effect - Clinical Codes	No Consequences Or Impact To Patient (2199); No Known Impact Or Consequence To Patient (2692)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The investigation is still in progress.Once the investigation is complete a supplemental report will be filed.
Event or Problem Description
It was reported that the bulb syringe in the vaginal delivery kits were flat.They tried to suction a baby at delivery and the bulb syringe would not function.
Event or Problem Description
It was reported that the bulb syringe in the vaginal delivery kits were flat.They tried to suction a baby at delivery and the bulb syringe would not function.
Additional Manufacturer Narrative
The device was not returned for evaluation.A potential failure mode could be ¿inadequate performance during intended use - can¿t inject or withdraw fluid¿ with a potential root cause of ¿part weight/dimensions incorrect - cannot create adequate suction¿.The lot number is unknown therefore the device history record could not be reviewed."sec.801.116 medical devices having commonly known directions: a device shall be exempt from section 502(f)(1) of the act insofar as adequate directions for common uses thereof are known to the ordinary individual." h11:section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.H3 other text : the device was not returned.

• Brand Name: EAR / ULCER SYRINGE (BLUE) 2 OZ. BULK / 250
• Common Device Name: EAR SYRINGE
• Manufacturer (Section D): C.R. BARD, INC. (COVINGTON) -1018233; 8195 industrial blvd; covington GA 30014
• MDR Report Key: 9484032
• Report Number: 2020394-2019-05658
• Device Sequence Number: 16929461
• Product Code: KYZ
• UDI-Device Identifier: 10801741075985
• UDI-Public: (01)10801741075985
• Combination Product (Y/N): N
• Initial Reporter State: IL
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: other,user facility
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 01/16/2020

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 Catalogue Number: 9035820
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 11/29/2019
• Supplement Date Received by Manufacturer: 01/06/2020
• Initial Report FDA Received Date: 12/17/2019
• Supplement Report FDA Received Date: 01/16/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1