HyperFormTM

GUDID 00847536005419

104-4415 HYPERFORM 4X15MM BALLOON SYS

Micro Therapeutics, Inc.

Intravascular occluding balloon catheter, image-guided

• Primary Device ID: 00847536005419
• NIH Device Record Key: 4846d2de-540f-41ad-b326-5c6e78c7d965
• Commercial Distribution Status: In Commercial Distribution
• Brand Name: HyperFormTM
• Version Model Number: 104-4415
• Company DUNS: 826110710
• Company Name: Micro Therapeutics, 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: true
• 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
• 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
• 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 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit
• Storage Environment Temperature: Between 50 Degrees Fahrenheit and 90 Degrees Fahrenheit

Device Identifiers

Device Issuing Agency	Device ID
GS1	00847536005419 [Primary]

FDA Pre-market Approvals/Notifications & deNovo

• Premarket Notification: K101570

FDA Product Code

• MJN: Catheter, intravascular occluding, temporary

Sterilization

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

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

[00847536005419]

Ethylene Oxide

Device Entry Metadata

• Public Version Status: Update
• Device Record Status: Published
• Public Version Number: 5
• Public Version Date: 2019-03-21
• Device Publish Date: 2016-08-19

On-Brand Devices [HyperFormTM]

• 00847536005853: 104-4770 HYPERFORM 7X7MM BALLOON SYS
• 00847536005822: 104-4770 HYPERFORM 7X7MM BALLOON SYS
• 00847536005792: 104-4715 HYPERFORM 7X15MM BALLOON SYS
• 00847536005761: 104-4715 HYPERFORM 7X15MM BALLOON SYS
• 00847536005549: 104-4470 HYPERFORM 4X7MM BALLOON SYS
• 00847536005501: 104-4470 HYPERFORM 4X7MM BALLOON SYS
• 00847536005471: 104-4420 HYPERFORM 4X20MM BALLOON SYS
• 00847536005419: 104-4415 HYPERFORM 4X15MM BALLOON SYS
• 00847536005358: 104-4370 HYPERFORM 3X7MM BALLOON SYS
• 00847536005327: 104-4370 HYPERFORM 3X7MM BALLOON SYS
• 00847536005174: 104-4153 HYPERFORM 3X15MM BALLOON SYS
• 00847536005143: 104-4153 HYPERFORM 3X15MM BALLOON SYS