Class 2 Device Recall CAPNOSTREAM 20P (US) N ROHS

• Date Initiated by Firm: July 31, 2018
• Create Date: October 03, 2018
• Recall Status: Terminated on September 20, 2022
• Recall Number: Z-0022-2019
• Recall Event ID: 80895
• 510(K)Number: K112368
• Product Classification: Oximeter - Product Code DQA
• Product: CAPNOSTREAM 20P (US) N - ROHS, Part Number CS08651-02
• Code Information: B836141101 B836141102 B836141103 B836141104 B836141106 B836141107 B836141108 B836141109 B836141110 B836141111 B836141113 B836141116 B836141117 B836141118 B836141119 B836141120 B836141121 B836141122 B836141123 B836141124 B836141125 B836141126 B836141127 B836141128 B836141130 B836141131 B836141133 B836141134 B836141135 B836141136 B836141137 B836141138 B836141139 B836141140 B836141141 B836141142 B836141143 B836141144 B836141145 B836141146 B836141147 B836141148 B836141149 B836141150 B836141151 B836141152 B836141153 B836141154 B836141155 B836141156 B836141157 B836141158 B836141159 B836141160 B836141161 B836141162 B836141163 B836141164 B836141165 B836141166 B836141167 B836141169 B836141170 B836141172 B836141173 B836141174 B836141175 B836141176 B836141177 B836141105 B836141112 B836141179 B836141180 B836141181 B836141182 B836141184 B836141185 B836141186 B836141187 B836141188 B836141189 B836141190 B836141192 B836141193 B836141195 B836141197 B836141199 B836141200 B836141201 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• Recalling Firm/ Manufacturer: Oridion Medical 1987 Ltd.; Har Hotzvim Industrial Park Box 45025; Har Hotzvim Industrial Park; Jerusalem Israel
• Manufacturer Reason for Recall: The date/time, nurse call and alarm settings of the bedside patient monitors may reset to the factory default settings when the monitor is powered off.
• FDA Determined Cause: Nonconforming Material/Component
• Action: Urgent Medical Device Correction notification letters dated 7/31/18 were distributed to customers. The letters included the following instructions for customers: Share this notification with all care environments where the Capnostream" 20 and Capnostream" 20p bedside patient monitors are used, particularly in the areas where nurse call may be enabled (general care floors). If your facility has distributed these bedside patient monitors to other persons or facilities, please promptly forward a copy of this letter to those recipients. Medtronic is recommending continued use of Capnostream" devices. Users should confirm that the date/time is accurately displayed. If the date/time requires reset, all user defined settings, such as alarms and nurse call, will also require reset until the software is updated. Please follow the instruction in the Operators Manual to set user-defined default settings. The Operators Manual is available at http://www.medtronic.com/covidien/enus/support/product-manuals.html, refer to the Institutional Settings section. Return the completed Acknowledgement and Receipt Form by fax or email even if you have no inventory. In October 2018, download the software update from the Medtronic website via the following link which includes directions on how to download and install the software: http://www.medtronic.com/covidien/en-us/support/patient-monitoring-equipmentsoftware-upgrades.html.
• Quantity in Commerce: 10356
• Distribution: The products were distributed US nationwide and Puerto Rico. The products were distributed to the following foreign countries: Argentina, Australia, Austria, Bahrain, Belgium, Canada, Columbia, Costa Rica, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Japan, Kazakhstan, Kuwait, Mexico, Netherlands, Norway, Oman, Pakistan, Panama, Peru, Philippines, Poland, Portugal, Qatar, Romania, Russia, Saudi Arabia, Serbia, Singapore, Slovakia, Slovenia, South Africa, Spain, Sweden, Switzerland, Thailand, Tunisia, Turkey, UAE, UK, and Vietnam.
• Total Product Life Cycle: TPLC 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) Database: 510(K)s with Product Code = DQA and Original Applicant = ORIDION MEDICAL 1987 LTD.