MAUDE Adverse Event Report: Merit Maquiladora Mexico Achieve®; Instrument, Biopsy

Catalog Number	A1825/B
Medical Device Problem Code	Failure to Obtain Sample (2533)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/01/2026
Type of Reportable Event	Malfunction

• Brand Name: Achieve®
• Common Device Name: Instrument, Biopsy
• Manufacturer (Section D): Merit Maquiladora Mexico; avenida sor juana ines de la; 19970 interior b, edificio 2; tijuana baja california, 22630 ; MX 22630
• Manufacturer (Section G): Merit Maquiladora Mexico; avenida sor juana ines de la; 19970 interior b, edificio 2; tijuana baja california, 22630 ; MX 22630
• Manufacturer Contact: lisa perz msn, rn, pmp ; 1600 merit parkway; south jordan, UT 84095 ; +1(801)208-4225
• MDR Report Key: 50720157
• Report Number: 3011642792-2026-00198
• Device Sequence Number: 10696345
• Product Code: KNW
• UDI-Device Identifier: 00884450443941
• UDI-Public: 00884450443941
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K141552
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility
• Type of Report: Initial,Followup
• Report Date (Section B): 09/28/2026

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
• Device Catalogue Number: A1825/B
• Device Lot Number: I3315431
• 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: 08/14/2026
• Supplement Date Received by Manufacturer: 09/28/2026
• Initial Report FDA Received Date: 09/10/2026
• Supplement Report FDA Received Date: 09/28/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 09/11/2025
• Is the Device Labeled for Single Use? (Y/N): Yes
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 84 YR
• Patient Sex: Male
• Patient Weight: 184 LB
• Patient Race: White