GUDID 00763000812041

CAP 5867-3M STERILE MDR

MEDTRONIC, INC.

Pacing/defibrillation lead cap kit

• Primary Device ID: 00763000812041
• NIH Device Record Key: f517f793-4dbc-41d7-9793-4f62ac3c8811
• Commercial Distribution Status: In Commercial Distribution
• Version Model Number: 5867-3M
• Company DUNS: 006261481
• Company Name: MEDTRONIC, INC.
• Device Count: 1
• DM Exempt: false
• Pre-market Exempt: false
• MRI Safety Status: Labeling does not contain MRI Safety Information
• Human Cell/Tissue Product: false
• Device Kit: false
• Device Combination Product: false
• Single Use: true
• Lot Batch: true
• Serial Number: false
• Manufacturing Date: false
• Expiration Date: false
• Donation Id Number: false
• Contains Natural Rubber Latex: false
• Labeled No Natural Rubber Latex: false
• RX Perscription: true
• OTC Over-The-Counter: false

Customer Support Contacts

• Phone: +1(800)633-8766
• Email: Corporate.UDI@medtronic.com
• Phone: +1(800)633-8766
• Email: Corporate.UDI@medtronic.com
• Phone: +1(800)633-8766
• Email: Corporate.UDI@medtronic.com
• Phone: +1(800)633-8766
• Email: Corporate.UDI@medtronic.com
• Phone: +1(800)633-8766
• Email: Corporate.UDI@medtronic.com
• Phone: +1(800)633-8766
• Email: Corporate.UDI@medtronic.com

Operating and Storage Conditions

• Storage Environment Temperature: Between 59 Degrees Fahrenheit and 86 Degrees Fahrenheit
• Storage Environment Temperature: Between 59 Degrees Fahrenheit and 86 Degrees Fahrenheit
• Storage Environment Temperature: Between 59 Degrees Fahrenheit and 86 Degrees Fahrenheit
• Storage Environment Temperature: Between 59 Degrees Fahrenheit and 86 Degrees Fahrenheit
• Storage Environment Temperature: Between 59 Degrees Fahrenheit and 86 Degrees Fahrenheit
• Storage Environment Temperature: Between 59 Degrees Fahrenheit and 86 Degrees Fahrenheit

Device Identifiers

Device Issuing Agency	Device ID
GS1	00763000812041 [Primary]

FDA Pre-market Approvals/Notifications & deNovo

• Premarket Notification: K911048

FDA Product Code

• DTD: pacemaker lead Adaptor

Sterilization

• Steralize Prior To Use: false
• Device Is Sterile: true

Device Entry Metadata

• Public Version Status: New
• Device Record Status: Published
• Public Version Number: 1
• Public Version Date: 2025-04-21
• Device Publish Date: 2025-04-12

Devices Manufactured by MEDTRONIC, INC.

• 00199150007172 - NA: 2025-04-21 CUSTOM PACK PDBB11V44R10 CORE PIX
• 00199150007547 - NA: 2025-04-21 CUSTOM PACK SSBB10Z49R20 NEW CONFIG
• 00763000812041 - NA: 2025-04-21CAP 5867-3M STERILE MDR
• 00763000812041 - NA: 2025-04-21 CAP 5867-3M STERILE MDR
• 00763000812058 - NA: 2025-04-21 SERVICE KIT 5873C LEAD MDR
• 00763000947064 - Bio-Medicus™: 2025-04-21 CANNULA 96530-115 BIO-MEDICUS 15FR
• 00763000947071 - Bio-Medicus™: 2025-04-21 CANNULA 96530-117 BIO-MEDICUS 17FR
• 00763000947088 - Bio-Medicus™: 2025-04-21 CANNULA 96530-119 BIO-MEDICUS 19FR
• 00763000947095 - Bio-Medicus™: 2025-04-21 CANNULA 96530-121 BIO-MEDICUS 21FR