| Class 2 Device Recall Type S Extension for use with Varian, CIVCO | |
Date Initiated by Firm | May 12, 2020 |
Date Posted | June 02, 2020 |
Recall Status1 |
Terminated 3 on March 25, 2021 |
Recall Number | Z-2243-2020 |
Recall Event ID |
85654 |
510(K)Number | K933227 |
Product Classification |
Accelerator, linear, medical - Product Code IYE
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Product | Type S Extension For use with Varian, CIVCO, Prescription Only - Product Usage: Device is intended for patient positioning. |
Code Information |
Part Number: MTCFHNV UDI: 00841439104156 Lot Numbers: M027990; M505880; M847500; M166160; M505890; M858580; M198170; M505900; M858590; M241650; M505910; M869030; M249180; M511240; M885500; M257630; M530920; M918000; M278760; M541350; M919980; M282330; M553300; M919990; M283380; M553720; M928400; M293670; M553740; M928410; M300750; M596220; M934260; M303010; M596230; M936110; M314410; M616690; M942400; M321880; M616700; M942510; M323560; M649630; M944110; M326580; M649670; M951030; M333420; M649770; M964730; M350700; M715520; M979830; M356130; M715540; M987460; M362290; M743010; M995860; M365740; M767820; M369700; M774760; M371990; M782390; M418080; M796350; M436620; M796360; M439700; M802120; M442410; M805650; M446460; M809050; M448260; M809060; M457870; M820300; M457880; M829290; M462640; M834400; M493710; M844990; M495030; M845000 |
Recalling Firm/ Manufacturer |
Med Tec Inc 1401 8th St Se Orange City IA 51041-7463
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For Additional Information Contact | 712-737-8688 |
Manufacturer Reason for Recall | Potential for disengagement of the Varian Style Type-S Extension during patient repositioning. The risk associated with the disengagement of the extension could be a patient fall if the patient is not supported by clinical staff. |
FDA Determined Cause 2 | Component design/selection |
Action | On May 14, 2020, the firm sent a notification letter titled, "Urgent: Field Safety Notice Customer/Distributor Communication," to customers and distributors.
The customer notification stated that a new warning will be added to the instruction manual at the next revision. The warning will state:
To prevent extension from unintended disengagement, do not lift patient vertically to reposition while immobilized under a thermoplastic mask.
Extensions that were further distributed, should be notified.
An acknowledgement form should be returned to the firm by 05/29/2020. In addition, customers need to complete a form which states that they have been informed of the field safety notice involving the Type-S Extension, Varian Style and that notice has been read and understood by all operators of the device. In addition, the customers need to review their inventory for the affected products. Customers need to identify whether they no longer have the Type-S Extension, Varian Style or currently have the Type-S Extension, Varian Style. Customers need to acknowledge that have read and understand the Field Safety Notification and notified users of the device to not lift the patient vertically to reposition while immobilized under a thermoplastic mask. Customers need to identify the quantity of the devices at the facility, as well as, lot numbers and serial numbers.
The forms should be returned by FAX or email to:
Attention: CIVCO Radiotherapy Type-S Extension
North American Customer use: Order@CivcoRT.com or 1-800-842-8688
International Customers use: DistorderCivcoRT.com or 1-712-737-8688
Customers can contact the firm's sales representative for additional assistance by calling the firm between 8:00AM and 5:00PM CST.
The firm's distributor notification letters stated that the firm has initiated a field action due to the potential for disengagement of the Type-S Extension, Varian Style during patient setup and/or repositioning. The firm has iden |
Quantity in Commerce | 171 units |
Distribution | Worldwide distribution - US Nationwide distribution including in the states of WI, TX, AZ, FL, NE, TN, MA, FL, GA, IN, OR, PA, IL, LA, NH, MS, MI, OH, MN, VA, IA, CA, NC, SC, AK, UT, WA, MO, MT, KS, and WV.
The countries of Africa, Colombia, Saudi Arabia, Costa Rica, South Korea, Hungary, Spain, and Italy. |
Total Product Life Cycle | TPLC Device Report |
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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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510(K) Database | 510(K)s with Product Code = IYE
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