| Brand Name | BD Luer-Lok |
| Common Device Name | Piston Syringe |
| Manufacturer (Section D) |
| BECTON DICKINSON DE MEXICO |
| autopista |
| 55 59 99 8400, k.m. 37.5 |
| cuautitlan izcalli |
|
| Manufacturer (Section G) |
| BECTON DICKINSON DE MEXICO |
| autopista |
| 55 59 99 8400, k.m. 37.5 |
| cuautitlan izcalli |
|
| Manufacturer Contact |
|
helen
cox (mdr)
|
| 75 north fairway drive |
| vernon hills, IL 60061
|
|
+1(847)393-5694
|
|
| MDR Report Key | 50676786 |
| Report Number | 9614033-2026-00051 |
| Device Sequence Number | 10423492 |
| Product Code |
FMF
|
| UDI-Device Identifier | 30382903096573 |
| UDI-Public | (01)30382903096573 |
| Combination Product (Y/N) | N |
| Initial Reporter State | IL |
| Initial Reporter Country | US |
| PMA/510(K) Number | K110771 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Distributor |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/01/2026 |
| 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 |
Other
|
| Device Expiration Date | 09/08/2026 |
| Device Catalogue Number | 309657 |
| Device Lot Number | 6015788 |
| 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 | 08/24/2026 |
| Initial Report FDA Received Date | 09/08/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 02/13/2026 |
| 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 |
|
|