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U.S. Department of Health and Human Services

Class 2 Device Recall CV Basin Procedure Pack

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 Class 2 Device Recall CV Basin Procedure Packsee related information
Date Initiated by FirmJanuary 25, 2021
Create DateFebruary 19, 2021
Recall Status1 Terminated 3 on July 21, 2022
Recall NumberZ-1138-2021
Recall Event ID 87218
510(K)NumberK842648 
Product Classification General surgery tray - Product Code LRO
ProductCV Basin Set Pack, REF numbers: a) 89-7935.11 b) 89-7935.12 c) 89-7935.13 d) 89-7935.14 e) 89-7935.15 f) 89-7935.16 Custom surgical procedure packs including sternum saw blades.
Code Information a) 89-7935.11, Lot codes: 48285959 exp 12/21/2022  b) 89-7935.12, Lot codes: 49057260 exp 5/1/2023, 49239952 exp 4/1/2023, 49481001 exp 6/1/2023, 49603726 exp 8/1/2023, 49864125 exp 7/1/2021  c) 89-7935.13, Lot codes: 50404644 exp 11/1/2021, 50698398 exp 11/1/2023 d) 89-7935.14, Lot codes: 5125317 exp 6/1/2022  e) 89-7935.15, Lot codes: 51305461 exp 2/1/2024, 51983318 exp 2/1/2024 f) 89-7935.16, Lot codes: 53324463 exp 12/1/2024  
Recalling Firm/
Manufacturer		 DeRoyal Industries Inc
200 Debusk Ln
Powell TN 37849-4703
For Additional Information ContactTheresa Marsee
865-362-6465
Manufacturer Reason
for Recall		Sternum saw blades within procedure packs are not sterile. The surgical saw blade has a green non-sterile sticker.
FDA Determined
Cause 2		Process control
ActionDeRoyal issued their recall on 01/25/2021 to the end user level by emailing recall letters to its direct accounts. The direct accounts were instructed to forward our recall notification to their customers. The direct accounts and their customers were asked to identify the affected products and return the provided notice of credit form back to DeRoyal.
Quantity in Commerce309 packs
DistributionDistributors in OK, MI, and TX.
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 For details about termination of a recall see Code of Federal Regulations (CFR) Title 21 §7.55.
510(K) Database510(K)s with Product Code = LRO
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