MAUDE Adverse Event Report: BARD ACCESS SYSTEMS BARD POLY MIDLINE CATHETER 4F SL; CATHETER,INTRAVASCULAR,THERAPEUTIC,SHORT-TERM LESS THAN 30 DAYS

Model Number	N/A
Medical Device Problem Code	Expiration Date Error (2528)
Health Effect - Clinical Code	No Patient Involvement (2645)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The manufacturer has received the sample and will evaluate.Results are expected soon.A lot history review (lhr) of reds3530 showed two other similar product complaint(s) from this lot number.The complaints for this lot number (reds3530) have been reported from the same facility.
Event or Problem Description
It was reported that the ultrasound gel in two midline kits was expired.Product was not used on a patient.12/17/2019 - kit was shipped between november 5 - december 10, 2019.This report addresses the first kit.
Event or Problem Description
It was reported that the ultrasound gel in two midline kits was expired.Product was not used on a patient.12/17/2019 - kit was shipped between (b)(6) - (b)(6) 2019.This report addresses the first kit.
Additional Manufacturer Narrative
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.The device has not been returned to the manufacturer for evaluation.A lot history review (lhr) of reds3530 showed two other similar product complaint(s) from this lot number.The complaints for this lot number (reds3530) have been reported from the same facility.

• Brand Name: BARD POLY MIDLINE CATHETER 4F SL
• Common Device Name: CATHETER,INTRAVASCULAR,THERAPEUTIC,SHORT-TERM LESS THAN 30 DAYS
• Manufacturer (Section D): BARD ACCESS SYSTEMS; 605 n. 5600 w.; salt lake city UT 84116
• MDR Report Key: 9548409
• Report Number: 3006260740-2019-04055
• Device Sequence Number: 2245212
• Product Code: LJS
• UDI-Device Identifier: 00801741137716
• UDI-Public: (01)00801741137716
• Combination Product (Y/N): N
• Initial Reporter State: NJ
• Initial Reporter Country: US
• PMA/510(K) Number: K001901
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 02/12/2020

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: Health Professional
• Device Expiration Date: 10/31/2020
• Device Model Number: N/A
• Device Catalogue Number: CK000716
• Device Lot Number: REDS3530
• Was Device Available for Evaluation?: No
• Date Returned to Manufacturer: 12/11/2019
• Event Location: Hospital
• Initial Date Received by Manufacturer: 12/11/2019
• Supplement Date Received by Manufacturer: 01/31/2020
• Initial Report FDA Received Date: 01/03/2020
• Supplement Report FDA Received Date: 02/12/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1