MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP; NEEDLE,HYPODERM,SAFETY,27GX1.25

Catalog Number	SSN100276Z
Medical Device Problem Code	Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	01/17/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
According to the facility the needles have clogged issues.The ma draws up medication with a needle and attaches it to the syringe.
Additional Manufacturer Narrative
According to the facility the needles have clogged issues.The ma draws up medication with a needle and attaches it to the syringe.The doctor is not able to inject the medication once it has been inserted into a patient, has to draw the needle back out, attach another needle, and then insert the needle again.It has been determined that the reported event could cause or contribute to serious injury if it were to occur.In an abundance of caution, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.

• Common Device Name: NEEDLE,HYPODERM,SAFETY,27GX1.25
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093 2753
• Manufacturer Contact: alex mathew ; three lakes drive; northfield, IL 60093-2753 ; 2249317042
• MDR Report Key: 21376349
• Report Number: 1417592-2025-00075
• Device Sequence Number: 12917611
• Product Code: FMI
• UDI-Device Identifier: 10193489032024
• UDI-Public: 10193489032024
• Combination Product (Y/N): N
• Initial Reporter State: OR
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 02/13/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Catalogue Number: SSN100276Z
• Device Lot Number: 89724030001
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 01/27/2025
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/17/2025
• Initial Report FDA Received Date: 02/13/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown