| Brand Name | JELCO |
| Common Device Name | CATHETER,INTRAVASCULAR,THERAPEUTIC,SHORT-TERM LESS THAN 30 DAYS |
| Manufacturer (Section D) |
| ICU MEDICAL, INC. |
| 4455 atherton dr |
| salt lake city UT 84123 |
|
| MDR Report Key | 24965429 |
| Report Number | 24965429 |
| Device Sequence Number | 10496111 |
| Product Code |
FOZ
|
| UDI-Device Identifier | 15019517078428 |
| UDI-Public | (01)15019517078428 |
| Combination Product (Y/N) | N |
| Initial Reporter State | AZ |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
User Facility
|
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
04/14/2026 |
| Report Date (Section F) |
04/14/2026 |
| 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 | 3266 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Was the Report Sent to FDA? |
Yes
|
| Event Location |
Hospital
|
| Date Report to Manufacturer | 04/23/2026 |
| Initial Date Received by Manufacturer | Not provided |
| Initial Report FDA Received Date | 04/23/2026 |
| Usage of Device |
Unknown
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Sex | Unknown |
| Date Report Sent to FDA | 04/14/2026 |
|
|