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U.S. Department of Health and Human Services

Class 2 Device Recall Excelsior Medical

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  Class 2 Device Recall Excelsior Medical see related information
Date Initiated by Firm June 05, 2014
Date Posted July 16, 2014
Recall Status1 Terminated 3 on August 19, 2015
Recall Number Z-2070-2014
Recall Event ID 68573
510(K)Number K913804  
Product Classification Set, i.V. Fluid transfer - Product Code LHI
Product Excelsior Medical Sterile Triple Lead Tubing Set and Sterile Heavy Duty Triple Lead Tubing Set. To be used with the Pharm-Assist Dispensing Pump. Used for drug reconstitution and/or fluid transfer
Code Information Product Code PA03 - Lot Nos.: 03030813, 03050813 and 03091213  Product Code BX03, Lot Nos.: 64031513, 64073113, 64081313, 64090513
Recalling Firm/
Excelsior Medical Corp
1933 Heck Ave
Neptune NJ 07753
For Additional Information Contact Mr. John M. Linfante
Manufacturer Reason
for Recall
There is a potential for a leak. A molding defect in the connector that joins the three leads to the main flow line may allow fluid to escape or air to enter the fluid path during transfer of fluids from one container to another.
FDA Determined
Cause 2
Nonconforming Material/Component
Action Excelsior Medical issued "Urgent Medical Device Recall" notifications/"Customer Reply Forms" dated June 5, 2014 to affected customers via certified mail (return receipt request). The notice informed customers of the issue with the affected product; how to identify affected product; instructed the customers to discontinue use of tubing sets from the affected lots and return the attached form (Customer Reply Form) via fax to Excelsior to make arrangements for return of product. If product was further distributed by the customer the notification instructs them to identify the customer(s) that it was supplied to and notify them at once of the product recall. A phone number was provided in case customers had questions regarding the recall (1.800.487.4276 8:30 am - 5:00 pm EST) as well as an email address (recall12@excelsiormedical.com).
Quantity in Commerce 4250 tubing sets (PA03 - 78 cases; BX03 - 92 cases (each case contains 25 tubing sets))
Distribution Worldwide Distribution - USA (nationwide) and 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 = LHI and Original Applicant = EXCEL MEDICAL, INC.