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2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN

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Page 1: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 2: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 3: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 4: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 5: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN

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11. HCT/Ps DESCRIBED IN 21 CFR 1271.10

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Page 6: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN

See

Inst

ruct

ions

for

OM

B S

tate

men

t. F

OR

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PP

RO

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-054

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xpira

tion

Dat

e: 3

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FOR

M F

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- 33

56 (5

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Page 7: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 8: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 9: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN

See Instructions for OMB Statement. FORM APPROVED:OMB No.0910-0543. Expiration Date: 613012020 DEPARTMENT OF HEALTH AND HUMAN SERVICES 1. REGISTRATION NUMBER 2. REASON FOR SUBMISSION VALIDATION--FOR FDA USE ONLY 1

PUBLIC HEALTH SERVICE (FDA Establishment Identifier) a. D INITIAL REGISTRATION I LISTING VALIDATED BY FDA:21-NOV-2017 FOOD AND DRUG ADMINISTRATION b. D ANNUAL REGISTRATION I LISTING DISTRICT: Dallas

ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN CELLS, TISSUES, FEI: 3009234552 c. 00 CHANGE IN INFORMATION

PRINTED BY FDA:27-JAN-2018 AND CELLULAR AND TISSUE-BASED PRODUCTS (HCT/Ps)

(See reverse side for instructions) d. D INACTIVE PART 1- ESTABLISHMENT INFORMATION PART II- PRODUCT INFORMATION C'le o:::o- me ;a ""m mm!'J ::Oin 3. OTHER FDA REGISTRATIONS 10. ESTABLISHMENT FUNCTIONS AND TYPES OF HCT IPs -o h>::O 8cns;:

Establishment Functions ::ta; 14. PROPRIETARY a. BLOOD FDA 2830 NO. :...m em"' NAME(S) e>e me ,... e Types of HCT I Ps z e )lo

b. DEVICES FDA 2891 NO. Recover Screen Test Package Process Store Label Distribute C'lln ::0 (I) m c: (I) G') en c. DRUG FDA 2656 NO.

4. PHYSICAL LOCATION (Include legal name, number and street, city, state, country, and post office code) a. Bone X X X X X X X *** See full text on next pag<

CellRight Technologies b. Cartilage

1808 Universal City Blvd c. Cornea Universal City, Texas 78148 d. Dura Mater

0SIP e. Embryo 0 Directed

a. PHONE 210-659-9353 EXT 0 Anonymous b.o SATELLITE RECOVERY ESTABLISHMENT

f. Fascia X X X X X X X D(MANUFACTURING ESTABLISHMENT FEI NO. c. TESTING FOR MICRO-ORGANISMS ONLY

5. ENTER CORRECTIONS TO ITEM 4 g. Heart Valve

h. Ligament X X X X X X X

0 SIP 6. MAILING ADDRESS OF REPORTING OFFICIAL (Include institution name if applicable, i. Oocyte 0 Directed number and street, city, state, country, and post office code) 0 Anonymous

Cel!Right Technologies j . Pericardium X X X X X X X Attn: Robin M. Sullivan, DC, CTBS

1808 Universal City Blvd k. Peripheral 0 Autologous Universal City, Texas 78148 Blood Stem 0 Family Related

0AIIogeneic

I. Sclera

OSIP a. PHONE 210-659-9353 EXT m. Semen 0 Directed 7. ENTER CORRECTIONS TO ITEM 6 0 Anonymous

b. PHONE X X X X X X X MatrixiQ Dermis, DermaPure n. Skin

o. Somatic Cell 0 Autologous Therapy 0 Family Related Products 0

8. U.S. AGENT p. Tendon X X X X X X X

q. Umbilical Cord Blood 0 Family Related

0AIIogeneic

a. E-MAIL r. Vascular Graft

s. Amniotic Membrane X X X X X X X

. 07ff t. a. TYPED NAME Robin M. Sullivan, DC, CTBS b. E-MAIL [email protected]

u.

c. TITLE VP of Regulatory Affairs d. DATE 21-NOV-2017 v.

FORM FDA • 3356 (7/17)

Page 10: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN

DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE

FOOD AND DRUG ADMINISTRATION ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN CELLS, TISSUES,

AND CELLULAR AND TISSUE-BASED PRODUCTS (HCT/Ps) (See reverse side for instructions)

ADDITIONAL INFORMATION:

Proprietary Name(s): a. Bone MatrixOI, FlexiT, Influx, MatrixCellect I 00 DBM

Putty, MatrixCellect I 00 DBM Crunch, ConCelltrate 100, Denta!Fix

FORM FDA - 3356 (7/17)

1. REGISTRATION NUMBER (FDA Establishment Identifier)

FEI: 3009234552

See Instructions for OMS Statement. FORM APPROVED:OMB No.0910-0543. Expiration Date: 6/30/2020

Page:2

Page 11: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 12: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 13: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN
Page 14: 2018 DermaPure VAC Binder FINAL 2018-0220 w clinical ...VALIDATED BY FDA:17-NOV-2015 DISTRICT: Cincinnati PRINTED BY FDA:03-DEC-2015 ESTABLISHMENT REGISTRATION AND LISTING FOR HUMAN