| Brand Name | BD Luer-Lok |
| Common Device Name | Piston Syringe |
| Manufacturer (Section D) |
| BD INFUSION THERAPY SYSTEMS INC. S.A. DE C.V. |
| periferico luis donaldo |
| colosio no. 579 |
| nogales |
| MX |
|
| Manufacturer (Section G) |
| BD INFUSION THERAPY SYSTEMS INC. S.A. DE C.V. |
| periferico luis donaldo |
| colosio no. 579 |
| nogales |
|
MX
|
|
| Manufacturer Contact |
|
helen
cox (mdr)
|
| 75 north fairway drive |
| vernon hills, IL 60061
|
|
+1(847)393-5694
|
|
| MDR Report Key | 50211063 |
| Report Number | 9610847-2026-00335 |
| Device Sequence Number | 6122246 |
| Product Code |
FMF
|
| UDI-Device Identifier | 30382903097037 |
| UDI-Public | (01)30382903097037 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MO |
| Initial Reporter Country | US |
| PMA/510(K) Number | K110771 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
08/31/2026 |
| 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 | 309703 |
| Device Lot Number | 5245839 |
| Was Device Available for Evaluation? |
No
|
| Date Returned to Manufacturer | 07/24/2026 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/17/2026 |
| Supplement Date Received by Manufacturer | 08/31/2026
|
| Initial Report FDA Received Date | 08/11/2026 |
| Supplement Report FDA Received Date | 09/10/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 09/26/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Sex | Unknown |
|
|