| Brand Name | PEN NDL 32G 6MM 3B TW 100CT US |
| Common Device Name | Needle, Hypodermic, Single Lumen |
| Manufacturer (Section D) |
| EMBECTA PENEL LIMITED - DUN LAOGHAIRE, Ireland |
| |
|
| Manufacturer Contact |
|
avital
merl
|
| 300 kimball dr. |
| parsippany, NJ 07054
|
|
| MDR Report Key | 50929625 |
| Report Number | 3023359743-2026-00452 |
| Device Sequence Number | 9508856 |
| Product Code |
FMI
|
| UDI-Device Identifier | 00382903207497 |
| UDI-Public | 00382903207497 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NY |
| Initial Reporter Country | US |
| PMA/510(K) Number | K213478 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Consumer |
| Type of Report
| Initial |
| Report Date (Section B) |
09/29/2026 |
| 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 |
Lay User/Patient
|
| Device Model Number | 320749 |
| Device Lot Number | 4114084 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 10/15/2024 |
| Initial Report FDA Received Date | 09/29/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
| Patient Sequence Number | 1 |
| Patient Sex | Female |
|
|