Charcoal Output Filter ICM-000-0421

GUDID 00817688021704

I.C. MEDICAL, INC.

Surgical plume evacuation system

• Primary Device ID: 00817688021704
• NIH Device Record Key: 3f93eb7d-0292-4757-9edb-99e9f30b6071
• Commercial Distribution Status: In Commercial Distribution
• Brand Name: Charcoal Output Filter
• Version Model Number: 2220
• Catalog Number: ICM-000-0421
• Company DUNS: 616182895
• Company Name: I.C. MEDICAL, 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: false
• Lot Batch: true
• Serial Number: false
• Manufacturing Date: true
• Expiration Date: false
• Donation Id Number: false
• Contains Natural Rubber Latex: false
• Labeled No Natural Rubber Latex: true
• RX Perscription: true
• OTC Over-The-Counter: false

Device Identifiers

Device Issuing Agency	Device ID
GS1	00817688021704 [Primary]

FDA Pre-market Approvals/Notifications & deNovo

• Premarket Notification: K932230

FDA Product Code

• FYD: Apparatus, Exhaust, Surgical

Sterilization

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

Device Entry Metadata

• Public Version Status: Update
• Device Record Status: Published
• Public Version Number: 5
• Public Version Date: 2019-04-08
• Device Publish Date: 2016-09-24

On-Brand Devices [Charcoal Output Filter]

• 00817688021704: 2220
• 00817688021698: ICM-000-0025