- Physicians Office Resource

NA - AG-5076-241523

Device Description

A sterile clip intended to be placed short-term (<=30 days) within the gastrointestinal (GI) tract during an endoscopic procedure for endoscopic marking, haemostasis, tissue approximation, closure of luminal perforations, and/or for treating mucosal/submucosal defects. It is a metallic device with a clasping mechanism; a disposable applicator may be included. This is a single-use device.

Environmental Conditions

Storage Environment Humidity - Percent (%) Relative Humidity

80.00
N/A

Storage Environment Temperature - Degrees Celsius

40.00
-10.00

Device Sizes

No Data Available

Device Sterilization

Device Sterile: True

Sterilization Prior To Use: False

Sterilization Methods: No Data Available

Product Codes

Code: PKL

Device Name: Hemostatic Metal Clip For The Gi Tract

Device Class: 2

Physical State: Metal clips applied by a delivery system

Definition: Clip placement within the gastrointestinal (GI) tract for the purpose of endoscopic marking, hemostasis for mucosal/sub-mucosal defects, bleeding ulcers, arteries, polyps, diverticula in the colon, prophylactic clipping, anchoring feeding tubes, supplemental closure method of luminal perforations.

Submission Type ID: 1

Review Panel: GU

Review Code: N/A

Technical Method: N

Gmp Exempt Flag: Applies pressure to tissue

Life Sustain Support Flag: Y

Unclassified Reason: N/A

Implant Flag: Y

Target Area: Gastrointestinal tract

Regulation Number: 876.4400

Third Party Flag: N

Medical Specialty: GU

Device Identifiers

Device Id: 66959664911251

Device Type: Package

DeviceId Issuing Agency: GS1

Contains DI Number: 56959664911254

Package Quantity: 10

Package Discontinue Date: 1/1/2026 12:00:00 AM

Package Status: Not in Commercial Distribution

Package Type: N/A

Device Id: 56959664911254

Device Type: Package

DeviceId Issuing Agency: GS1

Contains DI Number: 06959664911259

Package Quantity: 5

Package Discontinue Date: 1/1/2026 12:00:00 AM

Package Status: Not in Commercial Distribution

Package Type: N/A

Device Id: 06959664911259

Device Type: Primary

DeviceId Issuing Agency: GS1

Contains DI Number: N/A

Package Quantity: N/A

Package Discontinue Date: N/A

Package Status: N/A

Package Type: N/A

Device Id: 26959664911253

Device Type: Package

DeviceId Issuing Agency: GS1

Contains DI Number: 16959664911256

Package Quantity: 10

Package Discontinue Date: N/A

Package Status: In Commercial Distribution

Package Type: N/A

Device Id: 16959664911256

Device Type: Package

DeviceId Issuing Agency: GS1

Contains DI Number: 06959664911259

Package Quantity: 10

Package Discontinue Date: N/A

Package Status: In Commercial Distribution

Package Type: N/A

Device Id: 46959664911257

Device Type: Package

DeviceId Issuing Agency: GS1

Contains DI Number: 36959664911250

Package Quantity: 25

Package Discontinue Date: 1/1/2026 12:00:00 AM

Package Status: Not in Commercial Distribution

Package Type: N/A

Device Id: 36959664911250

Device Type: Package

DeviceId Issuing Agency: GS1

Contains DI Number: 06959664911259

Package Quantity: 2

Package Discontinue Date: 1/1/2026 12:00:00 AM

Package Status: Not in Commercial Distribution

Package Type: N/A

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