MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP; TTL1LYR 18FR10ML 100%SILI UM TRAY

Catalog Number	URO170818
Medical Device Problem Codes	Break (1069); Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	02/06/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
According to the facility, "while drawing urine culture from sample port, the port snapped off causing leakage of urine, a break in sterility, and the foley catheter needed to be exchanged".The facility stated there was no harm during the incident and that the foley was replaced.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.Comes available this report will be reopened and reevaluated.
Event or Problem Description
According to the facility, "while drawing urine culture from sample port, the port snapped off causing leakage of urine, a break in sterility, and the foley catheter needed to be exchanged".

• Common Device Name: TTL1LYR 18FR10ML 100%SILI UM TRAY
• 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: 21528780
• Report Number: 1417592-2025-00123
• Device Sequence Number: 9560469
• Product Code: OHR
• UDI-Device Identifier: 10888277862630
• UDI-Public: 10888277862630
• Combination Product (Y/N): N
• Initial Reporter State: IL
• 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): 03/05/2025

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: URO170818
• Device Lot Number: 24DBK131
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/06/2025
• Initial Report FDA Received Date: 03/05/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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