| Brand Name | NaviCam |
| Common Device Name | NaviCam SB Capsule |
| Manufacturer (Section D) |
| AnX Robotica Corp. |
| 6010 w spring creek parkway |
| plano TX 75024 |
|
| Manufacturer (Section G) |
| Ankon Tehcnologies Co Ltd |
| b3-2, d3-4, biolake, no.666 |
| hi-tech road, east lake ntd |
| wuhan CN |
|
| Manufacturer Contact |
|
tim
thomas
|
| 6010 w spring creek parkway |
| plano, TX 75024
|
|
+1(770)480-2911
|
|
| MDR Report Key | 50908459 |
| Report Number | 3016544248-2026-00002 |
| Device Sequence Number | 17655669 |
| Product Code |
NEZ
|
| UDI-Device Identifier | 00810164590008 |
| UDI-Public | 00810164590008 |
| Combination Product (Y/N) | N |
| Initial Reporter State | AZ |
| Initial Reporter Country | US |
| PMA/510(K) Number | K233229 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional |
| Initial Reporter Occupation |
Nurse Practitioner
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/25/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
No
|
| Operator of Device |
Health Professional
|
| Device Catalogue Number | CP-US-7001 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Initial Date Received by Manufacturer | 09/02/2026 |
| Initial Report FDA Received Date | 09/26/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| 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;
Required Intervention;
Hospitalization;
|
| Patient Sex | Male |
|
|