MAUDE Adverse Event Report: COVIDIEN 60ML SYRINGE LUER LOCK TIP RP; NEEDLE, HYPODERMIC, SINGLE LUMEN

Model Number	8881560125
Medical Device Problem Codes	Break (1069); Fluid/Blood Leak (1250)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The complainant indicated that the device will not be returned for evaluation; therefore, a failure analysis is not available, and we are not able to determine the relationship between this device and the cause for this event.  as part of our manufacturing process, all device history records are reviewed and approved by quality, prior to release of product.  if additional information or the sample is received, the investigation will be reopened and responded to accordingly.
Event or Problem Description
The customer reported that during preparing the chemotherapy for hospital inpatient, while preparing doxorubicin syringe for intravenous (iv) administration, the luer lock portion of the syringe broke, when tapping the syringe to eliminate bubbles from the solution.Several drops fell and were absorbed by the chemo pad.The drug was transferred from the broken syringe to a new syringe using a needle, which slowed the preparation and wasted a small amount of drug.

• Brand Name: 60ML SYRINGE LUER LOCK TIP RP
• Common Device Name: NEEDLE, HYPODERMIC, SINGLE LUMEN
• Manufacturer (Section D): COVIDIEN; 1222 sherwood rd; norfolk NE 68701
• MDR Report Key: 9837109
• Report Number: 1915484-2020-01143
• Device Sequence Number: 2830066
• Product Code: FMI
• UDI-Device Identifier: 20884521012230
• UDI-Public: 20884521012230
• Combination Product (Y/N): N
• Initial Reporter State: MO
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: other
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 03/16/2020

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: No Information
• Device Model Number: 8881560125
• Device Catalogue Number: 8881560125
• Device Lot Number: 930914X
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/09/2020
• Initial Report FDA Received Date: 03/16/2020
• Patient Sequence Number: 1