MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP MEDLINE; ANGIOLOCK,MED/LRG,POLY,6/CT,14CT/BX

Catalog Number	MDS6PML1
Medical Device Problem Code	Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	01/26/2026
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reported that, "use of angiolock medium/large ligation clips during procedure failed to engage numerous times".Staff in the room opened a different pack of clips to use for the procedure.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
Use of angiolock medium/large ligation clips during procedure failed to engage numerous times.Tried another pack and same thing occurred.Had to use a different kind of clips to successfully complete procedure.

• Brand Name: MEDLINE
• Common Device Name: ANGIOLOCK,MED/LRG,POLY,6/CT,14CT/BX
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 24688110
• Report Number: 1417592-2026-00266
• Device Sequence Number: 15946711
• Product Code: DSS
• UDI-Device Identifier: 10193489144772
• UDI-Public: 10193489144772
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K220006
• 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): 03/25/2026

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: MDS6PML1
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/26/2026
• Initial Report FDA Received Date: 03/25/2026
• 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 Age: 79 YR
• Patient Sex: Male
• Patient Weight: 107 KG
• Patient Race: White