MAUDE Adverse Event Report: MEDLINE INDUSTRIES - NAMIC NAMIC; MMII,MP,2V,200S,RH,OFF,OEM

Catalog Number	80038200
Medical Device Problem Code	Connection Problem (2900)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	03/04/2026
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reportedd that "the syringe turns itself loose while injecting the contrast medium".To date, no information has been received to indicate that a user or a patient experienced a death, serious injury, medical intervention, follow-up care, or other adverse health impact associated with the reported problem/issue.In an abundance of caution, and in response to an fda 483 issued for cfn (b)(4) on 22-jan-2024, this medwatch is being filed for the reported problem/issue.If additional relevant information becomes available a supplemental medwatch will be filed.
Event or Problem Description
"syringe turns itself loose".

• Brand Name: NAMIC
• Common Device Name: MMII,MP,2V,200S,RH,OFF,OEM
• Manufacturer (Section D): MEDLINE INDUSTRIES - NAMIC; 10 glens falls technical park; glens falls NY 12801 3864
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 24741910
• Report Number: 3015910259-2026-00105
• Device Sequence Number: 9229856
• Product Code: DTL
• UDI-Device Identifier: 10193489066456
• UDI-Public: 10193489066456
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K782095
• 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): 03/31/2026

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: 80038200
• Device Lot Number: 0000151055
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/04/2026
• Initial Report FDA Received Date: 03/31/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 01/10/2025
• 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 Sex: Unknown