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U.S. Department of Health and Human Services

Class 2 Device Recall BD Pyxis Medstation

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 Class 2 Device Recall BD Pyxis Medstationsee related information
Date Initiated by FirmNovember 20, 2025
Date PostedDecember 19, 2025
Recall Status1 Open3, Classified
Recall NumberZ-0962-2026
Recall Event ID 97712
Product Classification Cabinet, table and tray, anesthesia - Product Code BRY
ProductBD Pyxis MedStation ES, REF: 323, BD Pyxis MedStation ES 7 Drawer Auxiliary, REF: 324, BD Pyxis MedStation ES Tower, REF: 352, BD Pyxis Pro 7-Drawer Auxiliary, REF: 1149-00, BD Pyxis Pro 7- Drawer Auxiliary with Secure Tower, REF: 1152-00, BD Pyxis Pro MedStation Main, REF: 1155-00, BD Pyxis CII Safe ES, REF: 1116-00
Code Information Firmware Version: 1.48. REF/UDI-DI: 323/10885403512667, 324/10885403512681, 352/10885403512674, 1149-00/10885403517822, 1152-00/10885403517839, 1155-00/10885403521300, 1116-00/10885403512605
FEI Number 2016493
Recalling Firm/
Manufacturer		 CareFusion 303, Inc.
10020 Pacific Mesa Blvd
San Diego CA 92121-4386
Manufacturer Reason
for Recall		Automated Dispensing Cabinets (ADC) received a Half Height CUBIE drawer firmware update, which caused a Cubie Insert event which prompts software to generate a duplicate address, which causes an error and the drawer to fail, which may lead to inability or delay in accessing stored items, delay in the replenishment of ADCs or patient specific medications stored outside of ADCs.
FDA Determined
Cause 2		Device Design
ActionOn 11/20/2025, correction notices were mailed and emailed to customers: 1) If a pocket fails with the error message of "Duplicate Address Detected," users with the proper permissions can leverage the "Recover Storage Space" functionality to eject the affected pocket and clear the error. Note: This does not resolve the Firmware v1.48 issue. This only clears the error message from the "Recover Storage Space" screen. Content stored within the affected CUBIE pocket will still need to be manually accessed once the CUBIE pocket is ejected. 2) Facilities should have comprehensive policies and procedures that outline alternative ways to access items, which may include removing from a different device or from pharmacy. 3. A redundant supply of all life sustaining medication should be kept in a nearby location to help mitigate the length of delay. 4. Firm recommends making a "code-box" or "crash cart" of medications that are readily available outside of an automated storage device in the event of an emergency. Facility policies and procedures should clearly identify when it is appropriate to access emergency medications. Refer to product user guide for additional information. 5. Keys can be used to manually access unavailable drawers. Keys must be readily available and retrievable to constitute risk mitigation. Hospital policies and procedures should be devised by the facility indicating location of keys along with how they are to be obtained and used in downtime scenarios. 6. Share and disseminate this notice within your facility network. 7. Complete and return the response form via email to BDRC21@bd.com Firm will install the firmware 1.49 upgrade either remotely or via a field service visit. Note: Firmware updates to main devices will update the Aux when connected to the main device. Firm contacts: Remediation Support: US-Pyxis-Field-Action-Remediation@bd.com Technical Support: bd.com/self-service, Phone:1-800-727-6102
Quantity in Commerce53669
DistributionWorldwide - US Nationwide distribution including in the states of CO, IN, OH, TX, KS, FL, GA, NC, CA, HI, IL, NY, MI, VA, AL, LA, NE, KY, OK, AR, TN, WY, NJ, WI, SD, AZ, NV, MO, MA, ID, WV, DE, PA, WA, MT, CT, IA, MD, PR, MN, NM, OR, VT, MS, ME, AK, UT, DC, GU, SC, NH, RI, ND, AS and the countries of CH, CA, KW, QA, NL, GB, UY, AU, NZ, BH, TH, SG, CN, FR, LB, BS, HK, TR, PL, AR, BR, CL, CO, MX, ES, BM, SA, IL.
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.
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