| Brand Name | Nexiva |
| Common Device Name | Peripheral IV Catheters |
| Manufacturer (Section D) |
| BECTON DICKINSON INFUSION THERAPY SYSTEMS INC. |
| 9450 south state street |
| sandy UT 84070 |
|
| Manufacturer (Section G) |
| BECTON DICKINSON INFUSION THERAPY SYSTEMS INC. |
| 9450 south state street |
|
| sandy UT 84070 |
|
| Manufacturer Contact |
|
helen
cox (mdr)
|
| 75 north fairway drive |
| vernon hills, IL 60061
|
|
+1(847)393-5694
|
|
| MDR Report Key | 50874627 |
| Report Number | 1710034-2026-01039 |
| Device Sequence Number | 10715822 |
| Product Code |
FOZ
|
| UDI-Device Identifier | 00382903835164 |
| UDI-Public | (01)00382903835164(11)260317(17)290228(10)6076391 |
| Combination Product (Y/N) | N |
| Initial Reporter State | IA |
| Initial Reporter Country | US |
| PMA/510(K) Number | SEE H.10 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
User Facility,Company Representative |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| 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 Catalogue Number | 383516 |
| Device Lot Number | 6076391 |
| Date Returned to Manufacturer | 09/17/2026 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 09/14/2026 |
| Supplement Date Received by Manufacturer | 10/01/2026
|
| Initial Report FDA Received Date | 09/23/2026 |
| Supplement Report FDA Received Date | 10/01/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 03/17/2026 |
| 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 |
| Patient Sex | Unknown |