MAUDE Adverse Event Report: CENTURION MEDICAL PRODUCTS MEDLINE; PICC KIT 4F SL PL MAX BARRIER

Catalog Number	DYNJ70141MBH
Medical Device Problem Code	Infusion or Flow Problem (2964)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/27/2026
Type of Reportable Event	Malfunction
Event or Problem Description
According to the facility, sometime in the past, staff were unable to flush the picc line or obtain blood return.The facility stated that the picc line had to be removed, and that a chest x-ray showed the picc line was in place.
Additional Manufacturer Narrative
According to the facility, sometime in the past, staff were unable to flush the picc line or obtain blood return.The facility stated that the picc line had to be removed and that a chest x-ray showed the picc line was in place.The customer reported that another company placed a picc line using their product.The individual is doing well.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.

• Brand Name: MEDLINE
• Common Device Name: PICC KIT 4F SL PL MAX BARRIER
• Manufacturer (Section D): CENTURION MEDICAL PRODUCTS; tri-state de mexico; s. de r.l; mexicali baja california, 21397 ,; MX 21397,
• Manufacturer Contact: alex mathew ; three lakes drive; northfield, IL 60093-2753 ; 2259317042
• MDR Report Key: 24441873
• Report Number: 3004519921-2026-00006
• Device Sequence Number: 21443349
• Product Code: LRO
• UDI-Device Identifier: 10653160362982
• UDI-Public: 10653160362982
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K213481
• 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): 02/25/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Catalogue Number: DYNJ70141MBH
• Device Lot Number: 2025080690
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/27/2026
• Initial Report FDA Received Date: 02/25/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 08/06/2025
• 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 Sex: Female
• Patient Weight: 128 KG