Patient Line Extension

GUDID 10896128002067

BELMONT INSTRUMENT CORPORATION

Heat-exchanging intravenous administration set

• Primary Device ID: 10896128002067
• NIH Device Record Key: 96cc9746-b6ab-4181-be32-5c792dbeaf1c
• Commercial Distribution Status: In Commercial Distribution
• Brand Name: Patient Line Extension
• Version Model Number: 903-00022
• Company DUNS: 078330362
• Company Name: BELMONT INSTRUMENT CORPORATION
• 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: true
• Expiration Date: true
• 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	10896128002067 [Primary]

FDA Pre-market Approvals/Notifications & deNovo

• Premarket Notification: K141654

FDA Product Code

• FRN: Pump, Infusion

Sterilization

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

Device Entry Metadata

• Public Version Status: Update
• Device Record Status: Published
• Public Version Number: 4
• Public Version Date: 2019-12-11
• Device Publish Date: 2016-09-23

On-Brand Devices [Patient Line Extension]

• 10896128002067: 903-00022
• 00896128002060: 903-00022P