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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP; CATHETER,FOLEY,100%SILICONE,16FR,30ML,LF

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MEDLINE INDUSTRIES, LP; CATHETER,FOLEY,100%SILICONE,16FR,30ML,LF Back to Search Results
Catalog Number DYND11532
Medical Device Problem Code Material Rupture (1546)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 09/24/2025
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
According to the customer, on (b)(6) 2025 "soon after insertion of the foley catheter - the balloon ruptures and falls out of place." the customer reported the foley was replaced as a result of the reported issue.The customer did not report any serious injury related to the reported incident.No additional details are available related to the customer reported issue.It has been determined that the reported event could cause or contribute to serious injury if it were to occur again.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.
 
Event or Problem Description
According to the customer, on (b)(6) 2025 "soon after insertion of the foley catheter - the balloon ruptures and falls out of place.".
 
Additional Manufacturer Narrative
Update to d9: device returned.Update to h3: device evaluated.Update to h6: type of investigation.Update to h6: investigation findings.
 
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Common Device Name
CATHETER,FOLEY,100%SILICONE,16FR,30ML,LF
Manufacturer (Section D)
MEDLINE INDUSTRIES, LP
three lakes drive
northfield IL 60093
Manufacturer Contact
danielle tognocchi
three lakes drive
northfield, IL 60093
MDR Report Key23404998
Report Number1417592-2025-00581
Device Sequence Number17378565
Product Code EZL
UDI-Device Identifier10080196170982
UDI-Public10080196170982
Combination Product (Y/N)N
Initial Reporter StatePA
Initial Reporter CountryUS
Number of Events Summarized1
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,Followup
Report Date (Section B) 11/20/2025
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
Operator of Device Health Professional
Device Catalogue NumberDYND11532
Device Lot Number59225030524
Was Device Available for Evaluation? Device Returned to Manufacturer
Is the Reporter a Health Professional? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 09/26/2025
Supplement Date Received by Manufacturer11/14/2025
Initial Report FDA Received Date10/28/2025
Supplement Report FDA Received Date11/20/2025
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured03/01/2025
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Unknown
Patient Sequence Number1
Outcome Attributed to Adverse Event Other;
Patient SexUnknown
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