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U.S. Department of Health and Human Services

Class 1 Device Recall DeRoyal

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  Class 1 Device Recall DeRoyal see related information
Date Initiated by Firm September 02, 2021
Date Posted September 29, 2021
Recall Status1 Terminated 3 on December 18, 2023
Recall Number Z-2499-2021
Recall Event ID 88660
510(K)Number K842648  
Product Classification General surgery tray - Product Code LRO
Product DeRoyal Procedure Packs containing Smiths Medical NORMOFLO Irrigation Warming Set
Code Information 1) CYSTO PACK PGYBK / 89-5721.03 Lot 46459298 exp 10/01/2021 Lot 47042849 exp 11/01/2021 Lot 47217717 exp 01/01/2022 Lot 47461066 exp 04/10/2022 Lot 47525103 exp 04/01/2022 Lot 47696113 exp 05/01/2022 Lot 48210787 exp 07/01/2022 Lot 49049665 exp 10/01/2022 Lot 47525103 exp 04/01/2022 Lot 49101769 exp 07/01/2022 Lot 49215918 exp 11/01/2022 Lot 49291064 exp 11/1/2022 Lot 49351178 exp 01/01/2023 Lot 49455989 exp 01/01/2023 Lot 49683631 exp 01/01/2023 Lot 50920251 exp 03/01/2023 Lot 51081699 exp 08/01/2023 Lot 51253374 exp 08/01/2023 Lot 52004222 exp 10/01/2023 Lot 52658453 exp 02/01/2024 Lot 53216841 exp 02/01/2024 Lot 53666480 exp 09/01/2024 Lot 54367035 exp 01/01/2025 2) GU TUR BASIN SET PGYBK / 89-6425.07 Lot 52173376 exp 10/1/2021 Lot 52902866 exp 12/01/2021 Lot 53216518 exp 12/01/2021 Lot 53331541 exp 12/01/2021 Lot 53411946 exp 03/01/2022 Lot 53598712 exp 02/01/2022 Lot 53784881 exp 09/01/2022 Lot 53888656 exp 03/01/2022 Lot 53964621 exp 03/01/2022 Lot 54009801 exp 08/01/2022 Lot 54246494 exp 09/01/2022
Recalling Firm/
Manufacturer		 Deroyal Industries, Inc. Lafollette
1501 E Central Ave
La Follette TN 37766-2892
For Additional Information Contact Theresa Marsee
865-362-6465
Manufacturer Reason
for Recall		 DeRoyal manufactured procedure packs containing a Smiths Medical NORMOFLO Irrigation Warming System which is recalled due to the potential for aluminum ions leaching into warming fluids.
FDA Determined
Cause 2		 Nonconforming Material/Component
Action DeRoyal issued their recall on 09/03/2021 to the end user level by emailing recall letters to its direct accounts. The direct accounts were instructed to forward our recall notification to their customers. The direct accounts and their customers were asked to identify the affected products and return the provided notice of credit form back to DeRoyal.
Quantity in Commerce 2880 units
Distribution US distribution in Florida and South Carolina.
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 = LRO and Original Applicant = DEROYAL INDUSTRIES, INC.
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