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U.S. Department of Health and Human Services

Class 2 Device Recall Tubing Pack

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  Class 2 Device Recall Tubing Pack see related information
Date Initiated by Firm January 03, 2018
Date Posted January 30, 2018
Recall Status1 Terminated 3 on October 05, 2020
Recall Number Z-0535-2018
Recall Event ID 78977
510(K)Number K171308  
Product Classification Catheter, cannula and tubing, vascular, cardiopulmonary bypass - Product Code DWF
Product Medtronic Custom Perfusion Systems, indicated for use in the extracorporeal circuit during cardiopulmonary bypass (CPB) surgical procedures.
Code Information a) REF 2815R1, UPN/GTIN: 20885074191038, Lot/Serial Numbers: 210937492, 213151103, 213671744  b) REF 2D25R6, UPN/GTIN: 00613994268174, Lot/Serial Numbers: 209533592, 209759280, 209948919, 210174899, 210377603,  210478517, 210591995, 210767149, 211011818, 211210404,  211243436, 211542842, 211761616  c) REF 9M68R, UPN/GTIN: 20643169876648, Lot/Serial Numbers: 212067087, 212796361  d) REF BB4B15R13, UPN/GTIN: 00643169845121, Lot/Serial Numbers: 211804184, 212073924, 212266962, 212268301, 212385983, 212552883,  212796215, 213248430, 213583108  e) REF BB4B15R14, UPN/GTIN: 00763000025878, Lot/Serial Numbers: 213801240, 213868837  f) REF BB9L72R, UPN/GTIN: 00643169845077, Lot/Serial Numbers: 211715103  g) REF BB9L72R1, UPN/GTIN: 00643169872127, Lot/Serial Numbers:  212020797, 212174623, 212193001, 212301586, 212355584, 212428238,  212626142, 212884370, 213001157, 213248459, 213631247, 213672934,  213802501, 214072742, 214093025  h) REF CB1Z87R11, UPN/GTIN: 00643169741591, Lot/Serial Numbers: 211755326  i) REF CB4L56R24, UPN/GTIN: 00643169735989, Lot/Serial Numbers: 211654744, 211654745, 211800954  j) REF CB4L56R26, UPN/GTIN: 00643169906181, Lot/Serial Numbers: 212294432, 212404544, 212447345, 212489670, 213251146, 213251166,  213358174, 213573495, 213623995, 214053395  k) REF CB5S68R3, UPN/GTIN: 20613994490760, Lot/Serial Numbers: 210937507  l) REF CB7X82R4, UPN/GTIN: 00643169471986, Lot/Serial Numbers: 211050766, 211320749  m) REF CB7X82R5, UPN/GTIN: 00643169789517, Lot/Serial Numbers:  211423503, 211443209, 211443210, 211885323, 211991293, 212154744,  212235237, 212274655, 212428312, 212473311, 212671632, 212962650,  213126447, 213292357, 213377926, 213445426, 213494394, 213494396,  213672914, 213906498, 214043035, 214093030  n) REF HY6Y19R5, UPN/GTIN: 00643169510432, Lot/Serial Numbers: 210802114, 210945613, 211114272, 211210180, 211327621, 211654742,  211846417, 212235012, 212545229, 212835348  o) REF HY8M65R2, UPN/GTIN: 00643169661295, Lot/Serial Numbers: 210952226, 211335076, 211558225, 211722651, 212028419, 212222066,  212355669, 213001001, 213719738  p) REF TL8W39R6, UPN/GTIN: 00643169715097, Lot/Serial Numbers: 210731697, 210838201, 210937704
Recalling Firm/
Manufacturer		 Medtronic Perfusion Systems
7611 Northland Dr N
Brooklyn Park MN 55428-1088
For Additional Information Contact Joey Lomicky
763-526-2494
Manufacturer Reason
for Recall		 Medtronic custom perfusion tubing packs contain Terumo OPS valves that were recalled due to a lack of flow through the valve.
FDA Determined
Cause 2		 Component change control
Action In response to an Urgent Safety Alert issued by Terumo Cardiovascular Systems (CVS) Medtronic initiated their safety alert verbally to their direct consignees on 10/23/2017, providing them with a copy of the Terumo Safety Alert dated 06/27/2017. The firm followed this action with a letter on 1/3/18 in which they stated that the action by Terumo CVS was changed to a recall, and , in response, Medtronic was following up as a recall and requested the products be returned.
Quantity in Commerce 2914 units
Distribution DE, IA, CA and Japan
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 = Medtronic, Inc.
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