Thermoformed plastic trays are manually stacked in a magazine where the bottom tray is released onto a dead plate. A pusher moves the tray to the front of the machine onto a pair of retracting shelves near the cartoner carrier bucket conveyor. A 3-axis, programmable, Cartesian pick and place, equipped with a detachable end effector, removes syringes and their corresponding plastic platforms from the trays, changes their pitch, and places them onto a flighted transfer belt arrangement. The pick and place shifts left and right to complete each row, and moves incrementally from row to row until the tray is empty. The empty tray is released by the retractable shelves to drop onto a lower level where a pusher deposits it in a collection drawer. The syringes are indexed forward into the carrier buckets of an intermittent motion horizontal cartoner. Farason handled integration with the cartoner from design to field integration.