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U.S. Department of Health and Human Services

Class 2 Device Recall Insufflation Tubing Sets

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  Class 2 Device Recall Insufflation Tubing Sets see related information
Date Initiated by Firm July 15, 2013
Date Posted August 28, 2013
Recall Status1 Terminated 3 on May 20, 2015
Recall Number Z-2113-2013
Recall Event ID 65764
Product Classification Tubing/tubing with filter, insufflation, laparoscopic - Product Code NKC
Product DeRoyal Insufflation Tubing sets:
1) REF 28-0206 Insufflation Tubing, Laparoscopic Rx Only
2) REF 28-0214 Hi-Flow Insufflation Tubing Rx Only
3) REF 28-0216 Tubing, Insuf w/.3 Micr Filter Rx Only
4) REF 28-0217 Insufflation Tubing, Laparoscopic Rx Only
5) REF 28-0208 Insufflation Tubing w/Vent Rx Only
6) REF 28-0212H Heated Hi-Flow Insufflation Tubing Rx Only.

Used during laparoscopic surgical procedures to aid in the insufflation of the abdomen.
Code Information All Lots of the Insufflation Tubing Sets are as follows: REF 28-0206 Insufflation Tubing, Laparoscopic, Lot #29074214; REF 28-0214 Hi-Flow Insufflation Tubing Lot #3194170; REF 28-0216 Tubing, Insuf w/.3 Micr Filter Lot #29074249; REF 28-0217 Insufflation Tubing, Laparoscopic Lot #32305010; DeRoyal REF 28-0208 Insufflation Tubing w/Vent Lot #29314302; DeRoyal REF 28-0212H Heated Hi-Flow Insufflation Tubing Lot #29000354.
Recalling Firm/
Manufacturer		 DeRoyal Industries Inc
200 Debusk Ln
Powell TN 37849-4703
For Additional Information Contact Sharon Cook
865-938-7828
Manufacturer Reason
for Recall		 DeRoyal Industries is recalling their product Insufflation Tubing Sets due to materials incompatibility which could possibly result in occlusion at or near the filter housing which could prevent the flow of gas through the device.
FDA Determined
Cause 2		 Packaging process control
Action The firm notified customers via letters dated 7/15/2013 sent UPS and via DeRoyal Representatives. Customers were asked to notify DeRoyal of any remaining inventory to return for replacement product or credit. Non-responders will receive additional notifications. Effectiveness checks will be performed by contacting non-responders by phone.
Quantity in Commerce 506,632 sets in US; 17,854 sets International
Distribution Worldwide Distribution-USA (nationwide) including DC and the states of AL, AR, AZ, CA, CO, CT, FL, GA, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WA, WI, WV, and the countries of Dubai, Arab Emirates, Quebec, Canada, Japan, and Ireland.
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.
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