AccessGUDID - DEVICE: Axiom® Hacienda Sump® (M6651111620)

GUDID

Device Identifier (DI) Information

Brand Name: Axiom® Hacienda Sump®
Version or Model: 111162
Commercial Distribution Status: In Commercial Distribution
Catalog Number:
Company Name: AXIOM MEDICAL, INCORPORATED

Primary DI Number: M6651111620
Issuing Agency: HIBCC
Commercial Distribution End Date:
Device Count: 1
Labeler D-U-N-S® Number*: 094439676 *Terms of Use

Device Description: Dual Lumen, Mediastinal, Round, Silicone, Rounded Closed Tip

Device Characteristics

What MRI safety information does the labeling contain?	Labeling does not contain MRI Safety Information
Device required to be labeled as containing natural rubber latex or dry natural rubber (21 CFR 801.437):	No
Device labeled as "Not made with natural rubber latex":	No
For Single-Use:	Yes
Prescription Use (Rx):	Yes
Over the Counter (OTC):	No
Kit:	No
Combination Product:	No
Human Cell, Tissue or Cellular or Tissue-Based Product (HCT/P):	No

GMDN

[?]

GMDN Term Code	GMDN Term Name	GMDN Term Definition	GMDN Term Status [?]	Implantable?
15270	Sump drain	A sterile, tube-like device that has a double lumen which is designed to establish a channel for the removal of fluids from a cavity by allowing air to enter the cavity through the smaller lumen which displaces fluid into the larger lumen. This is a single-use device.	Active	false

FDA Product Code

[?]

Product Code	Product Code Name
FEG	Tube, Double Lumen For Intestinal Decompression And/Or Intubation

FDA Premarket Submission

FDA Premarket Submission Number [?]	Supplement Number [?]
K771048	000

Device Exempt from Premarket Submission: No CLOSE

Sterilization

Device Packaged as Sterile: Yes
Requires Sterilization Prior to Use: No

Sterilization Method [?]
No Sterilization Methods Found

Storage and Handling

[?]

Storage and Handling
No storage/handling found

Clinically Relevant Size

[?]

Size Type Text
Device Size Text, specify: 18 FR

Device Record Status

Public Device Record Key: 7ab8e0fe-71ee-445c-8ebc-0c60fdd314ae
Public Version Date: July 06, 2018
Public Version Number: 3
DI Record Publish Date: September 23, 2016

Alternative and Additional Identifiers Additional Identifiers

Package DI

[?]

Package DI Number	Quantity per Package	Contains DI Package	Package Discontinue Date	Package Status	Package Type
M6651111623	10	M6651111621		In Commercial Distribution	Case
M6651111621	10	M6651111620		In Commercial Distribution	Box

Secondary DI

[?]

Issuing Agency [?]	Secondary DI Number
No Secondary DIs found

Unit of Use DI

[?]

Unit of Use DI Number: No Unit of Use DI Numbers Found CLOSE

Direct Marking (DM)

[?]

Device Subject to Direct Marking (DM), but Excepted: No
DM DI Different from Primary DI: No
DM DI Number: None
CLOSE

Production Identifier(s) in UDI

[?]

Lot or Batch Number: Yes
Serial Number: No
Expiration Date: Yes
Manufacturing Date: No
Donation Identification Number: No CLOSE

Customer Contact

[?]

Phone: 310-533-9020
Email: Sales@AxiomMed.com

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