Medical Device
Manufacturing
THE TRADE PAPER OF THE FACTORY FLOOR
Z-2383-2012Class II

Varian brand Clinac, Trilogy, Novalis Tx, Unique, linear accelerators; Model Number: H14, H18, H29...

Varian Medical Systems, Inc. / initiated 2012-08-14 / Terminated / root cause: manufacturing process

Varian Medical Systems, Inc. Oncology Systems began a recall of Varian brand Clinac, Trilogy, Novalis Tx, Unique, linear accelerators; Model Number: H14, H18, H29, Reference/FSCA Identifier: CP-08881; Product is... on . FDA classified it as Class II and gives the reason as "Some X-jaw (lower collimator jaw) carriers were made using the incorrect metal alloy, which can cause the jaw carrier to crack. If both carriers on the same X-jaw crack, the jaw would be able to move freely in the...". As of , the recall status on record is Terminated, and MDM tags the root cause as manufacturing process.

Recall record

Recall number
Z-2383-2012
Classification
Class II
Status
Terminated
Initiated
Posted
Terminated
Recalling firm
Varian Medical Systems, Inc.
Product
Varian brand Clinac, Trilogy, Novalis Tx, Unique, linear accelerators; Model Number: H14, H18, H29, Reference/FSCA Identifier: CP-08881; Product is manufactured and distributed by Varian Medical Systems Inc., Palo Alto, CA. 1) The Varian Low Energy Linear Accelerator is indicated for precision radiotherapy for lesions, tumors and conditions anywhere in the body when radiation treatment i is indicated. (2) The Varian High Energy Linear Accelerator is indicated for stereotactic radiosurgery and precision radiotherapy for lesions, tumors and conditions anywhere in the body when radiation treatment is indicated.
Product code
IYE Accelerator, Linear, Medical
Reason for recall
Some X-jaw (lower collimator jaw) carriers were made using the incorrect metal alloy, which can cause the jaw carrier to crack. If both carriers on the same X-jaw crack, the jaw would be able to move freely in the closed direction. The position readout interlock circuitry will not detect this jaw position deviation. This may lead to treatment with an under-dose of the intended target volume.
Root cause tag
manufacturing process
FDA root cause
Nonconforming Material/Component
Action
Varian sent an "URGENT MEDICAL DEVICE CORRECTION URGENT FIELD SAFETY NOTICE" dated August 14, 2012 to all affected customers. The letter identified the product, problem, and actions to be taken by the customers. Contact the firm at 1-888-827-4265 for questions regarding this recall.
Quantity in commerce
221 Units
Distribution
Worldwide Distribution.
Product codes and lots
LIST OF SERIAL NUMBERS:  H140863 ,H294608 ,H294669 ,H294732 ,H140865 ,H294610 ,H294670 ,H294733 ,H140866 ,H294611 ,H294671 ,H294734 ,H140867 ,H294612 ,H294672 ,H294735 ,H140868 ,H294613 ,H294673 ,H294736 ,H140869 ,H294614 ,H294674 ,H294737 ,H140870 ,H294615 ,H294675 ,H294738 ,H140871 ,H294616 ,H294676 ,H294739 ,H140872 ,H294617 ,H294677 ,H294740 ,H140873 ,H294618 ,H294678 ,H294741 ,H140874 ,H294619 ,H294679 ,H294742 ,H140875 ,H294620 ,H294680 ,H294743 ,H140876 ,H294621 ,H294681 ,H294744 ,H140877 ,H294622 ,H294682 ,H294745 ,H140878 ,H294623 ,H294683 ,H294746 ,H140879 ,H294624 ,H294684 ,H294747 ,H140880 ,H294625 ,H294685 ,H294748 ,H140881 ,H294626 ,H294686 ,H294749 ,H140882 ,H294627 ,H294687 ,H294750 ,H140883 ,H294628 ,H294688 ,H294751 ,H140884 ,H294629 ,H294689 ,H294752 ,H140885 ,H294630 ,H294690 ,H294753 ,H140886 ,H294631 ,H294691 ,H294754 ,H140887 ,H294632 ,H294692 ,H294755 ,H140888 ,H294633 ,H294693 ,H294756 ,H140889 ,H294634 ,H294694 ,H294757 ,H140890 ,H294635 ,H294695 ,H294758 ,H140891 ,H294636 ,H294696 ,H294759 ,H140892 ,H294637 ,H294697 ,H294760 ,H140893 ,H294638 ,H294698 ,H294761 ,H140895 ,H294639 ,H294699 ,H294762 ,H140896 ,H294640 ,H294700 ,H294763 ,H140897 ,H294641 ,H294701 ,H294764 ,H140898 ,H294642 ,H294702 ,H294765 ,H140899 ,H294643 ,H294704 ,H294766 ,H140900 ,H294644 ,H294705 ,H294767 ,H181175 ,H294645 ,H294706 ,H294768 ,H181176 ,H294646 ,H294707 ,H294769 ,H181177 ,H294647 ,H294708 ,H294770 ,H181178 ,H294648 ,H294709 ,H294771 ,H181179 ,H294649 ,H294710 ,H294772 ,H181180 ,H294650 ,H294711  ,H181181 ,H294651 ,H294712  ,H181182 ,H294652 ,H294713  ,H181183 ,H294653 ,H294714  ,H181184 ,H294654 ,H294715  ,H181185 ,H294655 ,H294716  ,H181186 ,H294656 ,H294717  ,H181187 ,H294657 ,H294718  ,H181188 ,H294658 ,H294719  ,H181189 ,H294659 ,H294720  ,H181190 ,H294660 ,H294722  ,H181191 ,H294661 ,H294723  ,H181192 ,H294662 ,H294724  ,H182000 ,H294663 ,H294726  ,H182001 ,H294664 ,H294727  ,H182002 ,H294665 ,H294728  ,H182003 ,H294666 ,H294729  ,H182005 ,H294667 ,H294730  ,H294607 ,H294668 ,H294731

Enforcement reports

One row per recalled product line
FDA enforcement reports joined to recall event Z-2383-2012
Recall numberClassStatusVoluntary or mandatedReport dateClassified
Z-2383-2012Class IITerminatedVoluntary: Firm initiated