MAUDE Adverse Event Report: MEDLINE INDUSTRIES, LP; NEEDLE,23GX1",REG,BEVEL

Catalog Number	SYR100235Z
Medical Device Problem Code	Connection Problem (2900)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/09/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
According to the customer, on (b)(6) 2025 "the 23 g needle was being used to administer an intramuscular gluteal injection" and the syringe "popped off the needle and the contents of the syringe sprayed out." the customer stated that "none or very little of the contents of the syringe were administered" and that the needle was "removed with no complications.".
Additional Manufacturer Narrative
According to the customer, on (b)(6) 2025 "the 23 g needle was being used to administer an intramuscular gluteal injection" and the syringe "popped off the needle and the contents of the syringe sprayed out." the customer stated that "none or very little of the contents of the syringe were administered" and that the needle was "removed with no complications." per the customer, the im injection was not repeated.The customer reported there was no serious injury, medical intervention, or follow-up care required related to the reported incident.No additional information is available at this time.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.
Additional Manufacturer Narrative
Update to d9: is this device available for evaluation/returned to manufacturer.Update to h3: device evaluated by manufacturer.Update to h6: type of investigation (b).Update to h6: investigation findings (c).

• Common Device Name: NEEDLE,23GX1",REG,BEVEL
• Manufacturer (Section D): MEDLINE INDUSTRIES, LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: jessica walter ; three lakes drive; northfield, IL 60093
• MDR Report Key: 23509627
• Report Number: 1417592-2025-00616
• Device Sequence Number: 9954956
• Product Code: FMI
• UDI-Device Identifier: 10080196305544
• UDI-Public: 10080196305544
• Combination Product (Y/N): N
• Initial Reporter State: FL
• 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,Followup
• Report Date (Section B): 12/05/2025

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
• Operator of Device: Health Professional
• Device Catalogue Number: SYR100235Z
• Device Lot Number: 250310
• 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: 10/14/2025
• Supplement Date Received by Manufacturer: 12/04/2025
• Initial Report FDA Received Date: 11/10/2025
• Supplement Report FDA Received Date: 12/05/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 03/10/2025
• 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 Age: 48 YR
• Patient Sex: Female