| Brand Name | MEDEX 4-WAY STOPCOCK |
| Common Device Name | STOPCOCK, I.V. SET |
| Manufacturer (Section D) |
| ICU MEDICAL, INC. |
| 6250 shier rings road |
| dublin OH 43016 |
|
| Manufacturer Contact |
|
reed
covert
|
| 6250 shier rings road |
| dublin, OH 43016
|
|
2247062300
|
|
| MDR Report Key | 25394831 |
| Report Number | 1526863-2026-00115 |
| Device Sequence Number | 10719127 |
| Product Code |
FMG
|
| UDI-Device Identifier | 10351688504173 |
| UDI-Public | (01)10351688504173 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CA |
| PMA/510(K) Number | UNKNOWN |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,User Facility |
| Initial Reporter Occupation |
Nurse
|
| Type of Report
| Initial |
| Report Date (Section B) |
06/04/2026 |
| 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 | MX9341L |
| Device Lot Number | UNKNOWN |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 05/19/2026 |
| Initial Report FDA Received Date | 06/04/2026 |
| 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 |
| Patient Sex | Unknown |
|
|