| Brand Name | BD VACUTAINER® CPT¿ CELL PREPARATION TUBE WITH SODIUM HEPARIN |
| Common Device Name | LYMPHOCYTE SEPARATION MEDIUM |
| Manufacturer (Section D) |
| BECTON DICKINSON & CO (FRANKLIN LAKES) |
| 1 becton drive |
| franklin lakes NJ 07417 |
|
| Manufacturer (Section G) |
| BECTON, DICKINSON & CO. (BROKEN BOW) |
| 150 south 1st avenue |
|
| broken bow NE 68822 |
|
| Manufacturer Contact |
|
anand
singh
|
| 1 becton drive |
| franklin lakes, NJ 07417
|
|
2018475186
|
|
| MDR Report Key | 25086643 |
| Report Number | 1917413-2026-00374 |
| Device Sequence Number | 13405281 |
| Product Code |
JCF
|
| UDI-Device Identifier | 30382903627531 |
| UDI-Public | (01)30382903627531(11)251114(17)261130(10)5318137 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | JA |
| PMA/510(K) Number | NA |
| 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) |
04/09/2026 |
| 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 |
Other
|
| Device Catalogue Number | 362753 |
| Device Lot Number | 5318137 |
| 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 | 04/08/2026 |
| Initial Report FDA Received Date | 05/05/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 11/14/2025 |
| 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 |