| Brand Name | MINILOC |
| Common Device Name | Port Access Needle |
| Manufacturer (Section D) |
| C.R. Bard, Inc. (BASD) -3006260740 |
| 605 north 5600 west |
| salt lake city 84116 |
|
| Manufacturer (Section G) |
| C.R. Bard, Inc. (BASD) -3006260740 |
| 605 north 5600 west |
|
| salt lake city UT 84116 |
|
| Manufacturer Contact |
|
yolanda
thompson
|
| 605 north 5600 west |
| salt lake city 84116
|
|
+1(801)595-0700
|
|
| MDR Report Key | 50858510 |
| Report Number | 3006260740-2026-06885 |
| Device Sequence Number | 9651634 |
| Product Code |
FPA
|
| UDI-Device Identifier | 00801741047541 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | BR |
| PMA/510(K) Number | K050600 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Distributor |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/09/2026 |
| 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 |
Health Professional
|
| Device Model Number | N/A |
| Device Catalogue Number | 0632010 |
| Device Lot Number | ASJWFC029 |
| 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 | 09/05/2026 |
| Initial Report FDA Received Date | 09/22/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 03/06/2025 |
| 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 |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Sex | Unknown |
|
|