| Brand Name | BD VACUTAINER® PLUS CITRATE TUBE |
| Common Device Name | TUBES, VIALS, SYSTEMS, SERUM SEPARATORS, BLOOD COLLECTION |
| Manufacturer (Section D) |
| BECTON, DICKINSON AND COMPANY (BD) |
| belliver way |
| belliver industrial estate |
| plymouth |
| UK |
|
| Manufacturer (Section G) |
| BECTON, DICKINSON AND COMPANY (BD) |
| belliver way |
| belliver industrial estate |
| plymouth |
|
UK
|
|
| Manufacturer Contact |
|
matt j.
connor
|
| 7 loveton circle |
| sparks, MD 21152
|
|
4103164000
|
|
| MDR Report Key | 22214509 |
| Report Number | 9617032-2025-01066 |
| Device Sequence Number | 8148966 |
| Product Code |
JKA
|
| UDI-Device Identifier | 50382903630481 |
| UDI-Public | (01)50382903630481(11)250113(17)250930(10)5013961 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | KU |
| PMA/510(K) Number | K013971 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Foreign,Company Representative |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
05/23/2025 |
| 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 Expiration Date | 09/30/2025 |
| Device Catalogue Number | 363048 |
| Device Lot Number | 5013961 |
| 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 | 05/19/2025 |
| Initial Report FDA Received Date | 06/16/2025 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 01/13/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |