Class 2 Device Recall Perfusion Tubing Set

• Date Initiated by Firm: November 09, 2018
• Create Date: January 23, 2019
• Recall Status: Terminated on May 03, 2022
• Recall Number: Z-0770-2019
• Recall Event ID: 81667
• 510(K)Number: K881330
• Product Classification: Catheter, cannula and tubing, vascular, cardiopulmonary bypass - Product Code DWF
• Product: Perfusion Pack, Rx only, Sterile EO
• Code Information: Lot Numbers: 1819000027, 1813500044, 1809300053, 1817900004, 1821900089, 1812100018, 1816200009, 1817600016, 1810600004, 1811400014, 1812000017, 1812700017, 1813500013, 1815500011, 1816400023, 1809400005, 1811600025, 1812000018, 1812700018, 1813500014, 1814100012, 1815800010, 1810600006, 1811300003, 1812000019, 1812700020, 1815500012, 1817600017, 1813400007, 1814200096, 1816200011, 1817100013, 1813600009, 1817100103, 1819100014, 1810600014, 1812000030, 1815600027, 1817200017, 1819100017, 1810600015, 1816300051, 1815800015, 1817800028, 1810100021, 1810800022, 1811500019, 1812200022, 1813500020, 1814400026, 1815800017, 1816500016, 1817900015, 1810000025, 1810800023, 1811400022, 1812200023, 1813400010, 1814100019, 1816300053, 1810100022, 1812000034, 1812700032, 1814400027, 1816400032, 1817800031, 1819200020, 1812700034, 1814900020, 1817600031, 1814300026, 1818400082, 1819700023, 1820400020, 1814100022, 1816400035, 1818600024, 1811000017, 1815100030, 1816400036, 1819000012, 1809500011, 1810700016, 1812000036, 1814100023, 1815800018, 1810200011, 1814900021, 1817900017, 1806000020, 1807200053, 1810700018, 1811300015, 1812700035, 1816400037, 1819000013, 1810000027, 1812800072, 1814900022, 1813700002, 1817700022, 1819200022, 1810100026, 1811400028, 1803900021, 1805300025, 1805900033, 1806600023, 1807100016, 1810700020, 1811500023, 1813700014, 1814400028, 1816200018, 1817200020, 1811600032, 1814900023, 1816500019, 1817900019, 1812800073, 1815800019, 1819000016, 1810600022, 1813600016, 1818300026, 1810200014, 1812200029, 1814200103, 1815600031, 1816400039, 1818400085, 1821100028, 1810600023, 1810900022, 1813000021, 1817900021, 1803600019, 1803800017, 1805900035, 1806100020, 1806700039, 1807400038, 1808600021, 1812900030, 1813000022, 1806600064, 1814400031, 1816500022, 1818300027, 1817200022, 1810800024, 1812300012, 1804500029, 1806000024, 1810600024, 1812300013, 1818300028, 1810800025, 1812300014, 1813600019, 1819100023, 1811400001, 1811300019, 1811600034, 1812200032, 1814400033, 1819000020, 1809400017, 1814900027, 1815600032, 1810600026, 1811600035, 1817700026, 1819200027, 1810100028, 1813400015, 1815800021, 1817600036, 1810200016, 1811400031, 1812700040, 1815500028, 1816200021, 1816500024, 1818600028, 1811500024, 1812900031, 1814400034, 1816900018, 1812900032, 1817100021, 1817800035, 1813000025, 1816300058, 1819200028, 1811400033, 1814200105, 1816900020, 1817900023, 1807800020, 1808100036, 1805200067, 1810100030, 1819200029, 1806000029, 1807400042, 1813400017, 1816200024, 1815000041, 1818600030, 1819100025, 1810800030, 1812300017, 1816200027, 1816400043, 1817000037, 1817600038, 1819300025, 1809300068, 1813600022, 1816400079, 1821100036, 1809500017, 1811500029, 1811600040, 1812200037, 1814300030, 1815100034, 1815800023, 1817000038, 1817700032, 1818600032, 1812100075, 1813400057, 1814200109, 1814300031, 1820600034, 1810600029, 1812900034, 1813500027, 1819000023, 1810800033, 1813000032, 1813700022, 1816500025, 1814400069, 1810600032, 1811500033, 1813400021, 1815100037, 1818400090, 1812900039, 1813500029, 1816500026, 1818600034, 1810800034, 1811300023, 1812000043, 1813700025, 1814900031, 1816200029, 1816500027, 1817000040, 1818300031, 1804600025, 1805800065, 1806600028, 1810100035, 1811600042, 1813500030, 1816200030, 1812200001, 1816400087, 1816400048, 1817600041, 1811000008, 1810800065, 1817100025, 1817600042, 1817900029, 1812000088, 1818600079, 1816400050, 1812900041, 1814100030, 1815800024, 1810100081, 1810700112, 1811300062, 1817600043, 1818300033, 1805200031, 1805900040, 1807200067, 1812100042, 1815000047, 1817100027, 1811500035, 1812800074, 1822100076, 1810900029, 1813000033, 1814200112, 1814900035, 1815600039, 1816400051, 1814100032, 1816900025, 1812200045, 1815600041, 1817000042, 1817900030, 1812000010, 1805200035, 1806600030, 1809500023, 1811400037, 1813600030, 1810000033, 1811600046, 1813000039, 1815100041, 1815800028, 1817100030, 1818400143, 1814900036, 1813600001, 1814100001, 1812300001, 1815100065, 1809500025, 1811400040, 1812200050, 1813500036, 1813700027, 1815800031, 1816500032, 1818600039, 1810600036, 1811500039, 1812900044, 1816200031, 1817000044, 1818400096, 1817700085, 1818600075, 1809900043, 1811600049, 1817700038, 1818600040, 1807100026, 1807800034, 1810000035, 1812300023, 1810700030, 1809900044, 1812200051, 1819000029, 1819200036, 1810600037, 1811500042, 1812200052, 1814900040, 1816200033, 1817800043, 1815800033, 1821200047, 1809500028, 1812000047, 1809900048, 1810800040, 1813500041, 1815500034, 1817700039, 1816500033, 1805100104, 1806400043, 1807400052, 1809500030, 1812100053, 1813500042, 1818400097, 1810200032, 1815600050, 1816500036, 1810800043, 1813400028, 1818300039, 1818400098, 1815600051, 1810800044, 1818300040, 1810200033, 1812300026, 1815100046, 1817800070, 1818600042, 1810100043, 1817200037, 1812000050, 1812300029, 1816300076, 1817700042, 1810100044, 1810700034, 1811400048, 1812300030, 1813700031, 1817200038, 1807100034, 1803700065, 1806400048, 1807100035, 1808500045, 1810800045, 1812000051, 1814300043, 1815700038, 1817700043, 1818600044, 1803700066, 1805200043, 1811400062, 1813400034, 1813700032, 1810700038, 1803600044, 1806100041, 1807100040, 1808800042, 1812300032, 1813600036, 1816200040, 1817900042, 1810800046, 1811500052, 1812800085, 1813600037, 1818600047, 1803700072, 1811600060, 1812700059, 1815800045, 1819100045, 1813600039, 1815800046, 1817800051, 1808600043, 1803600047, 1803700075, 1811000043, 1812700061, 1814400048, 1817800052, 1809500037, 1811000044, 1815500042, 1816400064, 1818600051, 1810000045, 1812000062, 1811300042, 1811600066, 1815500045, 1819000047, 1816400068, 1817100047, 1819100050, 1809500040, 1811600067, 1813500049, 1815000056, 1817800054, 1812000002, 1813700038, 1815800050, 1806400055, 1808500048, 1806600059, 1819000051, 1817800055, 1813400049, 1819000054
• Recalling Firm/ Manufacturer: LivaNova USA; 14401 W 65th Way; Arvada CO 80004-3503
• For Additional Information Contact: 303-467-6306
• Manufacturer Reason for Recall: 4-way stopcocks and stopcock manifold assembled in certain perfusion tubing systems, indicated for use in surgical procedures requiring extracorporeal support for periods of up to six hours, may leak or be occluded.
• FDA Determined Cause: Process control
• Action: On 11/09/2018 Medical Device Correction Notices were mailed to customers via UPS First Overnight. Customers were advised: 1) Inspect your stock and identify Perfusion Tubing System(s) belonging to the impacted lots in inventory, as noted in Attachment 1. 2) The recalling firm will be shipping one case of sterile stopcocks (part number: SCO4S) and manifolds (part number: 020581600) to your facility as an immediate replacement for those remaining that may be defective in your impacted Perfusion Tubing System stock. 3) As each affected pack is opened for use, please replace the original stopcocks in the pack with the spare provided by the firm. The original stopcocks should be destroyed/ discarded. 4) Contact your firm Representative if additional replacement stopcocks are required. In addition, customers were asked to complete and return the attached Customer Response Form. Also, to assure within their organization that the correction notice is communicated to all personnel who need to be aware of it. For questions about this Medical Device Correction, please contact (800) 986-4702 or e-mail USFSN@livanova.com
• Quantity in Commerce: 483
• Distribution: Worldwide Distribution - Domestic (US) Consignees: AR, AZ, CA, CO, CT, FL, GA, HI, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, NC, NE, NH, NJ, NM, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, VA, WA, WI, WV, MS; Foreign (OUS) Consignees: Canada
• 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 = DWF and Original Applicant = COBE LABORATORIES, INC.