| Brand Name | BONEE NEEDLE FOR BLADDER INJECTION |
| Common Device Name | ENDOSCOPIC NEEDLE, GENERAL-PURPOSE, SINGLE-USE |
| Manufacturer (Section D) |
| COLOPLAST A/S |
| 1 holtedam humlebaek, dk 3050 |
| humlebaek 3050 |
| DA 3050 |
|
| Manufacturer (Section G) |
| CMF-SARLAT |
| 9 avenue edmond rostand |
|
| sarlat la canéda cedex 24200 |
|
FR
24200
|
|
| Manufacturer Contact |
|
usbes
brian schmidt
|
| 1601 west river road n |
| minneapolis, MN 55411
|
|
| MDR Report Key | 23656021 |
| Report Number | 9610711-2025-00491 |
| Device Sequence Number | 17349294 |
| Product Code |
FBK
|
| UDI-Device Identifier | 03600040272930 |
| UDI-Public | 3600040272930 |
| Combination Product (Y/N) | N |
| Initial Reporter State | OK |
| Initial Reporter Country | US |
| PMA/510(K) Number | K090217 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
05/12/2026 |
| 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 Catalogue Number | NBI070 |
| Device Lot Number | 10402044_NBI0701400 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | Not provided |
| Supplement Date Received by Manufacturer | Not provided
|
| Initial Report FDA Received Date | 11/26/2025 |
| Supplement Report FDA Received Date | 05/12/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 06/26/2025 |
| 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 |