| Brand Name | Novum IQ |
| Common Device Name | Pump, infusion |
| Manufacturer (Section D) |
| BAXTER HEALTHCARE CORPORATION |
| deerfield IL |
|
| Manufacturer (Section G) |
| ORBRAY THAILAND CO., LTD. |
| northern region ind. estate |
| 60/29 moo 4, tambol banklang |
| a.muang, ban klang, lamphun NA 51000 |
|
TH
51000
|
|
| Manufacturer Contact |
|
|
| 25212 w. illinois route 120 |
| round lake, IL 60073
|
|
+1(224)270-5355
|
|
| MDR Report Key | 50459555 |
| Report Number | 1416980-2026-02764 |
| Device Sequence Number | 9973048 |
| Product Code |
FRN
|
| UDI-Device Identifier | 05413765852428 |
| UDI-Public | (01)05413765852428 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MO |
| Initial Reporter Country | US |
| PMA/510(K) Number | K242390 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Nurse
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
10/01/2026 |
| 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 Model Number | 40800BAXUS |
| Device Catalogue Number | 40800BAXUS |
| Device Lot Number | N/A |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/28/2026 |
| Supplement Date Received by Manufacturer | 09/28/2026
|
| Initial Report FDA Received Date | 08/26/2026 |
| Supplement Report FDA Received Date | 10/01/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|