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U.S. Department of Health and Human Services

Class 2 Device Recall Mavig Portegra 2

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 Class 2 Recall
Mavig Portegra 2
see related information
Date Posted June 16, 2009
Recall Status1 Terminated on September 01, 2009
Recall Number Z-1438-2009
Recall Event ID 51947
Premarket Notification
510(K) Numbers
K010721  K052202  K073290  K081022  K992660 
Product Classification System, X-Ray, Angiographic - Product Code IZI
Product Mavig Portegra 2 which is an accessory to the Siemens angiographic, fluoroscopic and radiographic imaging systems. Component material number 4787714 Upper Body radiation shield, Artis floor.
Code Information Used with the following systems 1) Artis Zee floor Model number 10094135 - Serial numbers: 135102, 135109, 135117, 135120, 135122, 135125, and 135143; 2) Artis Zee ceiling Model number 10094137 - Serial numbers: 146103, 146104, 146107, 146113, 146116, 146119, 146122, 146123, 146136, 146137, and 146138; 3) Artis Zee biplane Model number 10094141 - Serial numbers: 153101, 153102, 153106, 153107, 153110, 153112, 153113, 153119, 153120, 153122, 153124, 153125, 153128, 153130, 153135, 153141, and 153153; 4) Artis Zee floor MN Model number 10094142 - Serial number: 140100; 5) Multistar D Model number 3772501 - Serial number: 1175 and 1667; 6) Axiom Iconos R200 Model number 5902775 - Serial number 2145; 7) Axiom Artis FC Model number 5904433 - Serial numbers: 10073, 10305, 10477, and 10488; 8) Axiom Artis MP Model number 5904466 - Serial numbers: 20313, 20321, 20338, and 20348; 9) Axiom Artis BC Model number 5904649 - Serial number: 14112; 10) Axiom Artis BA Model number 5904656 - Serial numbers: 28012, 28033, and 28067; 11) Axiom Artis TA Model number 7007755 - Serial numbers: 32042, 32048, and 32106; 12) Axiom Artis dTA Model number 7008605 - Serial numbers: 55070, 55217, 55218, 55219, 55220, 55223, 55228, 55230, 55231, 55232, 55233, 55238, 55241, 55243, 55246, 55249, 55250, 55254, 55256, 55259, 55260, 55262, 55263, 55269, 55273, 55274, 55276, 55277, 55279, 55282, 55284, 55285, 55286, 55287, 55288, 55289, 5292, 55294, 55298, 55299, 55304, 55305, 55306, 55307, 55308, 55310, 55312, 55316, 55318, 55320, 55322, 55325, 55338, 55342, 55343, 55355, 55356, 55358, 55359, 55362, 55365, 55368, 55369, 55374, 55375, 55376, 55377, 55378, 55382, 55384, 55388, 55392, 55394, 55395, 55396, 55399, 55400, 55401, 55404, 55405, 55407, 55408, 55409, 55410, 55411, 55414, 55415, 55416, 55423, 55425, 55426, 55435, 55436, 55438, 55439, 55441, 55443, 55455, 55461, 55462, 55466, 55468, 55470, 55473, and 55513; 13) Axiom Artis dFC Model number 7412807 - Serial numbers: 35511, 35516, 35525, 35528, 35529, 35535, 35536, 35538, 35540, 35545, 35556, 35560, 35566, 35571, 35580, 35581, 35599, 35600, 35601, 35603, 35610, 35613, 35623, 35627, 35629, 35634, 35649, 35652, 35655, 35659, 35663, 35664, 35665, 35666, 35672, 35678, 35684, 35690, 35698, 35704, 35707, 35727, 35728, 35730, 35736, 35739, 35741, 35743, 35744, 35745, 35750, 35762, 35768, 35776, 35778, 35782, 35783, 35784, 35787, 35788, 35793, 35802, 35810, 35821, 35828, 35831, 35834, 35836, 35937, and 37713; 14) Axiom Artis dTC Model number 7413078 - Serial numbers: 46036, 46071, 46097, 46111, 46112, 46115, 46117, 46118, 46120, 46122, 46125, 46129, 46133, 46134, 46138, 46139, 46143, 46144, 46145, 46146, 46147, 46153, 46156, 46158, 46162, 46163, 46168, 46170, 46171, 46172, 46174, 46178, 46179, 46180, 46186, 46189, 46190, 46194, 46196, 46198, 46201, 46202, 46203, 46205, 46208, 46209, 46210, 46213, 46215, 46216, 46218, 46219, 46220, 46221, 46223, 46224, 46225, 46226, 46229, 46231, 46233, 46236, 46241, and 46245; 15) Axiom Artis dMP Model number 7555365 - Serial numbers: 57054, 57073, 57076, 57077, 57089, 57111, 57116, 57144, 57155, 57156, 57171, and 57189; 16) Axiom Artis dFA Model number 7555373 - Serial numbers: 50074, 50079, 50081, 50087, 50093, 50101, 50105, 50120, 50132, 50139, 50142, and 50161; 17) Axiom Artis dFC Model number 7727717 - Serial numbers: 40031, 40050, 40061, 40067, and 40071; 18) Axiom Artis TC Model number 7728350 - Serial number: 30005; 19) Axiom Artis dBC Model number 7728392 - Serial numbers: 44152, 44157, 44163, 44165, 44171, 44174, 44189, 44190, 44193, 44195, 44198, 44201, 44206, 44215, 44218, 44223, 44224, 44227, 44229, 44242, 44243, 44251, 44254, 44255, 44262, 44263, 44265, 44267, 44268, 44271, 44275, 44277, 44278, 44280, 44282, 44289, 44290, 44292, and 44304; 20) Somatom Definition AS Model number 8098027 - Serial numbers: 64064, 64065, 64067, 64068, 64071, 64074, 64077, 64078, 64081, 64082, 64085, 64087, 64091, 64097, 64103, 64104, 64105, 64111, 64112, 64113, 64114, 64115, 64117, 64118, 64122, 64123, 64138, 64140, 64142, 64145, 64154, 64164, 64166, 64168, 64169, 64170, 64171, 64172, 64177, 64178, 64179, 64180, 64181, 64190, 64194, 64199, 64202, 64212, 64214, 64228, 64231, 64232, 64235, 64236, 64239, 64241, 64243, 64244, 64245, 64246, 64247, 64248, 64253, 64258, and 64259.
Recalling Firm/
Manufacturer
Siemens Medical Solutions USA, Inc
51 Valley Stream Pkwy
Malvern, Pennsylvania 19355
For Additional Information Contact Michael Van Ryn
610-219-6300
Manufacturer Reason
for Recall
Improper installation of accessory support arm, which could potentially result in the loosening of the arm over time causing it to fall.
FDA Determined
Cause 2
OTHER/UNDETERMINED: Pending
Action The recalling firm has decided to inspect all of the installed units for this condition and where necessary replace the missing clip. The recalling firm has issued an Update Instructions AX011/09/S dated 03.09, which provides instructions on how to perform a visual inspection of the Mavig Portegra 2 arm for the presence of the safety clip and the installation instructions on how to properly install the clip if it is missing.
Quantity in Commerce 427 units
Distribution Nationwide Distribution.
Total Product Life Cycle TPLC Device Report

 
1 For details about termination of a recall see Code of Federal Regulations (CFR) Title 21 §7.55
2 Per FDA policy, recall cause determinations are subject to modification up to the point of termination of the recall.
510(K) Database 510(K)s with Product Code = IZI and Original Applicant = SIEMENS MEDICAL CORP.
510(K)s with Product Code = IZI and Original Applicant = SIEMENS MEDICAL SOLUTIONS USA, INC.
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