The da Vinci Xi and X surgical systems (IS4000 and IS4200)… recallZ-0275-2022 · Intuitive Surgical, Inc. · initiated Sep 21, 2021
Terminated
Is my device affected?
- Compare the model, catalog and lot or serial numbers on your device or its packaging with the code information below. A recall usually covers only specific models or lots.
- If yours is listed, follow the instructions from Intuitive Surgical, Inc. or your healthcare provider. The company's action is summarized under what the company is doing.
- Do not stop using a prescribed or implanted device on your own — talk to your healthcare provider first.
Where to find your model and lot numbers · What recall classes and statuses mean
Why it was recalled
Incorrect expiration date on its package labeling (shipper box and inner carton label).
FDA root cause category: Labeling Change Control
What the company is doing
On September 21, "Urgent Medical Device Recall"-customer letter was sent out to the affected sites, via FedEx and an updated letter with legible print of labels on October 21 to non-responder customers for incorrect expiration date on the package labeling (shipper box and inner carton) label. Both shipper and carton label had expiration date as 11/30/2023 instead of 01/31/2023. The Affected product is being requested to be returned per attached field safety notice (5556010-01 Rev A). The customers had been requested to fax or E-mail the acknowledgement form to, Attn: REGULATORY COMPLIANCE FIELD ACTIONS; Subject line for email: ISIFA2021-05-R Xi Drape Expiration Date U.S. Fax +1(408) 523-0619, or Scan and Email: [email protected]. The firm expects customers to call or email the firm with the unused quantities to receive the replacement or credit to return the affected devices, if customers call or send an E-mail. The firm will provide RMA when customers call the firm. Customers are advised to take actions as: Inform necessary hospital personnel about this issue. 2. Locate all affected products at their site and return to the firm via the standard RMA process. 3. Inform affected personnel when the requested actions have been completed. 4. Complete the attached Acknowledgement Form immediately and return to the firm via fax or email as instructed on the form. 5. Please retain a copy of this letter and the acknowledgement form for customer's files. Replacements will be provided against returned affected product. Customers are provided contact information as: Customers Clinical Sales Representative or contact at the numbers listed below: " North America: (800) 876-1310, Option 3 (4 AM to 5 PM PST) or mail: [email protected]. " South Korea: 02-3271-3200 (9 AM to 6 PM KSTJ)
Recall details
- Recall number
- Z-0275-2022
- Status
- Terminated
- Initiated by the company
- Sep 21, 2021
- Recalling firm
- Intuitive Surgical, Inc.
- Quantity
- 1,740 drapes (87 bobes)
- Product code
- NAY
- FDA submissions
- K131861
- Distribution
- Worldwide distribution - U.S. Nationwide distribution in the states of AL, CA, GA, IL, FL, CO, TX, MO, OH, MA, WI, NC, LA, UT and the country of South Korea.
Product description
The da Vinci Xi and X surgical systems (IS4000 and IS4200) each consist of three main components: the Surgeon Console (SC), the Vision Cart (VC), and the Patient Cart (PC). The Patient Cart is the operative component of the system and its primary function is to support the instrument arms and camera arm. The X/Xi Instrument Arm Drape is intended to be used with the instrument arms of the PC as a sterile barrier during clinical procedures, and makes the instrument arms sterile and suitable for surgery. X/Xi Instrument Arm Drapes are sterile unless the package is opened or damaged, and are indicated for a single use. The drapes are placed onto the instrument arms by two users (one sterile and one non-sterile)in tandem, with the non-sterile user leading the placement via drape cuff pockets.
Code information (models, lots, serial numbers)
Part number: 470015-07; Lot number: DM4210309; REF: 470015; UDI # 00886874112199.
Devices named in this recall
1 device in the FDA device registry whose identifier appears in the recall's code information.
- None 470015Intuitive Surgical, Inc. · System,surgical,computer controlled instrument1 recall1 report
Sources and updates
- Recall record: FDA Medical Device Recalls, file dated Oct 16, 2026 · View the FDA recall notice ↗
- Devices: FDA GUDID, file dated Oct 13, 2026. Devices are linked when their identifier (with a valid check digit) appears in the recall's code information.
- Page last rebuilt: Oct 16, 2026. Text above is shown as published by the FDA.
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