| Brand Name | Jelco ViaValve Safety IV Catheter |
| Common Device Name | Catheter, Intravascular, Therapeutic, Short-Term |
| Manufacturer (Section D) |
| ICU Medical, Inc. |
| 201 west queen st |
| southington CT 06489 |
|
| Manufacturer Contact |
|
reed
covert
|
| 951 calle amanecer |
| san clemente, CA 92673
|
|
+1(224)706-2300
|
|
| MDR Report Key | 50953337 |
| Report Number | 1219611-2026-00063 |
| Device Sequence Number | 10428973 |
| Product Code |
FOZ
|
| UDI-Device Identifier | 15019517078398 |
| UDI-Public | (01)15019517078398 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NA |
| Initial Reporter Country | CA |
| PMA/510(K) Number | K160235 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,User Facility |
| Initial Reporter Occupation |
Risk Manager
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/30/2026 |
| 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 | 326010 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 09/09/2026 |
| Initial Report FDA Received Date | 09/30/2026 |
| 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 |
|
|