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U.S. Department of Health and Human Services

Class 2 Device Recall Decompression of Choice (DOC)

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 Class 2 Device Recall Decompression of Choice (DOC)see related information
Date Initiated by FirmApril 29, 2024
Date PostedJuly 10, 2024
Recall Status1 Open3, Classified
Recall NumberZ-2326-2024
Recall Event ID 94815
510(K)NumberK101889 
Product Classification Equipment, traction, powered - Product Code ITH
ProductDecompression Table Model E9011. This device applies cervical and/or lumbar decompression with practitioner definable target treatment location, treatment pounds, and patterns of treatment.
Code Information UDI-DI 00850008449826; Model Number: E9011; Serial Numbers: WTN-DOC03132457209 WTN-DOC-3132457210, WTN-DOC03132457235, WTN-DOC03132457237, WTN-DOC03132457238, WTN-DOC03132457239 Expanded Recall serial numbers: WTN-DOC04262458492, WTN-DOC04262458490, WTN-DOC04262458487, WTN-DOC04262458488, WTN-DOC04262458489, WTN-DOC0332457239, WTN-DOC04082457899, WTN-DOC04262458484, WTN-DOC03132457238, WTN-DOC03132457237, WTN-DOC03132457210, WTN-DOC04082457897, WTN-DOC04082457898, WTN-DOC03132457201, WTN-DOC04192458307, WTN-DOC04082457896, WTN-DOC03132457209, WTN-DOC03132457235, WTN-DOC04262458496, WTN-DOC03132457240, WTN-DOC03132457241, WTN-DOC04082457882, WTN-DOC04172458185, WTN-DOC04082457893, WTN-DOC04082457894, WTN-DOC04082457895
FEI Number 3007278668
Recalling Firm/
Manufacturer		 Pivotal Health Solutions, Inc.
3003 9th Ave Sw
Watertown SD 57201-8014
For Additional Information ContactKyle Boyer
605-753-0110
Manufacturer Reason
for Recall		This product is being recalled due to potentially insufficient rework on a part (E7130-B) on the lumbar section of the frame on 6 distributed tables. There were 4 additional tables with the faulty E7130-B part that were manufactured, but had not been distributed yet.
FDA Determined
Cause 2		Nonconforming Material/Component
ActionConsignees were initially notified of the recall via phone call starting on 4/29/2024. A followup email or certified mail were sent to the consignees on 6/11/2024. Customers were instructed that Fed Ex was contacted for pickup of the table so the table can be packaged and returned to Pivotal Health Solutions at 3003 9th Ave. SW, Watertown, SD 57201. A recall expansion led to a second updated recall notification being sent to consignees beginning on June 26, 2024 via email. This letter instructs the consignees to stop using the tables listed in the letter. The firm will be contacting the consignees to schedule an engineer to come out to the consignee site to inspect the table(s). The table(s) will be replaced in found to contain an affected part. The consignee is also asked to return a response form.
Quantity in Commerce32 tables
DistributionDistributed to CA, FL, TX, ID, GA, and TN
Total Product Life CycleTPLC Device Report
1 A record in this database is created when a firm initiates a correction or removal action. The record is updated if the FDA identifies a violation and classifies the action as a recall, and it is updated for a final time when the recall is terminated. Learn more about medical device recalls.
2 Per FDA policy, recall cause determinations are subject to modification up to the point of termination of the recall.
3 The manufacturer has initiated the recall and not all products have been corrected or removed. This record will be updated as the status changes.
510(K) Database510(K)s with Product Code = ITH
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