Refill Tray 50

GUDID B875500

Convenience kit no Lidocaine

Custom Interventional Pain Management, LLC

Intrathecal anaesthesia set, non-medicated

• Primary Device ID: B875500
• NIH Device Record Key: 09bbdcf7-0c4f-4916-bf85-b1290d281504
• Commercial Distribution Status: In Commercial Distribution
• Brand Name: Refill Tray
• Version Model Number: 50
• Catalog Number: 50
• Company DUNS: 030406006
• Company Name: Custom Interventional Pain Management, LLC
• Device Count: 1
• DM Exempt: false
• Pre-market Exempt: true
• MRI Safety Status: Labeling does not contain MRI Safety Information
• Human Cell/Tissue Product: false
• Device Kit: true
• Device Combination Product: true
• Single Use: true
• Lot Batch: true
• Serial Number: false
• Manufacturing Date: false
• Expiration Date: true
• Donation Id Number: false
• Contains Natural Rubber Latex: false
• Labeled No Natural Rubber Latex: false
• RX Perscription: true
• OTC Over-The-Counter: false

Device Identifiers

Device Issuing Agency	Device ID
HIBCC	B875500 [Primary]

FDA Product Code

• OGE: Epidural Anesthesia Kit

Sterilization

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

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

[B875500]

Ethylene Oxide

Device Entry Metadata

• Public Version Status: New
• Device Record Status: Published
• Public Version Number: 1
• Public Version Date: 2023-07-27
• Device Publish Date: 2023-07-19

Devices Manufactured by Custom Interventional Pain Management, LLC

• B875700 - Individual Ancillary Item Kit: 2023-09-19 Convenience kit non-medicated
• B87560LID0 - Discseel: 2023-08-23 Convenience kit with Lidocaine
• B875DSCLID0 - Discseel: 2023-08-23 Convenience kit with Lidocaine
• B875170 - Epidural Anesthesia Kit: 2023-07-27 Convenience kit no Lidocaine
• B87517LID0 - Epidural Anesthesia Kit: 2023-07-27 Convenience kit with Lidocaine
• B875180 - Epidural Anesthesia Kit: 2023-07-27 Convenience kit no Lidocaine
• B87518LID0 - Epidural Anesthesia Kit: 2023-07-27 Convenience kit with Lidocaine
• B875200 - Epidural Anesthesia Kit: 2023-07-27 Convenience kit no Lidocaine