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U.S. Department of Health and Human Services

Class 1 Device Recall Central Venous Tray, Triple Lumen Polyurethane

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  Class 1 Device Recall Central Venous Tray, Triple Lumen Polyurethane see related information
Date Initiated by Firm October 04, 2010
Date Posting Updated February 23, 2011
Recall Status1 Terminated 3 on June 21, 2011
Recall Number Z-1184-2011
Recall Event ID 57663
510(K)Number K072625  
Product Classification Peripherally Inserted, Central Venous Catheter Tray - Product Code LJS
Product Turbo-Ject PICC Tray, Power Injectable, Polyurethane Peripherally Inserted Central Venous Catheter,
5.0 Fr/ 60 cm, UPICDSY-5.0-CT-NT, G49169, Sterile, Cook Medical, Cook Incorporated, Bloomington, IN.
Code Information Part number: C-UPICDSY-5.0-CT-NT

Global part number G49169;

Lot numbers: 2244226, 2246219, 2251161, 2255157, 2264598, 2267957, 2267971, 2275435, 2275476, 2278549, 2278570, 2287707, 2287709, 2292788, 2292791, 2298486, 2302064, 2302098, 2306592, 2313790, 2317361, 2317382, 2321273, 2325079, 2327447, 2334833 and, 2335156. .
Recalling Firm/
Cook, Inc.
750 Daniels Way
Bloomington IN 47404-9120
For Additional Information Contact Rita A. Harden
Manufacturer Reason
for Recall
Cook, Inc. is recalling Single, Double, Triple, and Five-Lumen Central Venous Catheter Trays AND Single and Double Lumen PICC Peripherally Inserted Central Venous Catheter Trays. These kits and trays contain 0.9% Sodium Chloride Injection USP 5 mL fill in 6 mL flush syringes that have been recalled by Excelsior Medical. During a routine test for syringe sterility, a possible integrity failure wa
FDA Determined
Cause 2
Nonconforming Material/Component
Action Cook, Inc. sent URGENT DEVICE RECALLS letters to its customers dated 10/4/2010. The letters asked customers to examine their inventory and notify Cook for product return. The letter included a response form.
Quantity in Commerce 51,473 total kits/trays
Distribution Worldwide distribution: USA, Chile, Colombia, Panama, Barbados, Canada, Guatemala, and Saudi Arabia.
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 = LJS and Original Applicant = COOK, INC.