Class 2 Device Recall Lap/Pelviscopy Pack

• Date Initiated by Firm: April 22, 2015
• Create Date: October 20, 2016
• Recall Status: Terminated on October 25, 2016
• Recall Number: Z-0219-2017
• Recall Event ID: 71968
• Product Classification: Light, surgical, ceiling mounted - Product Code FSY
• Product: Laparoscopic Pack, Kit number AMS2499; ; convenience custom kits used for general surgery in hospital operating room
• Code Information: Lot numbers/Expiration dates: 62086 11/7/2015 65280 11/8/2015 62087 11/17/2015 65736 11/30/2015 64547 1/6/2016 67957 7/7/2016 67016 7/16/2016 67697 8/9/2016 69435 9/18/2016 70253 9/23/2016 70497 10/18/2016 70156 10/31/2016 70808 12/13/2016 71959 1/14/2017 73320 3/5/2017 72888 3/24/2017 73333 5/7/2017 75288 5/11/2017 76049 7/20/2017 78640 8/12/2017 78151 8/18/2017 76946 8/31/2017 77686 10/8/2017 77310 10/24/2017 69018 12/10/2017 78978 1/20/2018
• Recalling Firm/ Manufacturer: Windstone Medical Packaging, Inc.; 1602 4th Ave N; Billings MT 59101-1521
• For Additional Information Contact: Vicki Davis; 406-259-6387
• Manufacturer Reason for Recall: The Medtronic COVER LIGHT HANDLE DISPOSABLE GLOVES, Part # 13140, of the custom AMS kit were recalled because gloves may contain splits or holes compromising sterility.
• FDA Determined Cause: Unknown/Undetermined by firm
• Action: Aligned Medical Solutions (AMS) sent the Medtronic Urgent Medical Device for Devon Light Glove letter, dated April 23, 2015 to all affected consignees. Consignees were informed that the sterile kits assembled and distributed by AMS contain the recalled Devon COVER LIGHT HANDLE DISPOSABLE Glove (AMS part #13140 or Medtronic part # 571711) due to splits or holes. Consignees were advised to identify any remaining affected kits and follow the over-labeling instruction. At the time the kit is opened for use, any light gloves should be identified and disposed of pursuant to the medical waste policies in effect at your institution. AMS can provide replacement product if needed or you can contact your local Medtronic sales rep for sterile replacements as well. Due to the manufacturing process and finished sterilized packs in inventory, or at your facility, over labeling of inventory and/or future shipment affected by this recall will be labeled with a sticker attached to each pack. This sticker will read: RECALL NOTICE Medtronic announced the recall l of Devon Light Glove contained in this kit after it was sealed and sterilized. All other components in the kit are not affected by this recall. 1. At the time the kit is opened for use any Light Glove manufactured by Medtronic should be identified and set aside 2. The recalled light glove should be rendered unusable to protect against inadvertent use and disposed of pursuant to the medical waste policies in effect at your institution. Consignees should complete the attached Reply Form and fax to AMS at 406-256-9875. For any questions about this recall, please call 321-527-7714. For questions regarding this recall call 404-259-6387.
• Quantity in Commerce: 1290 kits
• Distribution: Nationwide Distribution to California, Florida, Georgia, Illinois, Kansas, Louisiana, Michigan, New Jersey, Nevada, Texas, Virginia, and Wyoming.
• 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.